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Full text of "The etiology of osseous deformities of the head, face, jaws and teeth"

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ETIOLOGY OF OSSEOUS DEFORMITIES 



OF THE 



HEAD. FACE, JAWS AND TEETH 

TALBOT 



THE ETIOLO 



Osseous Deformities 



HEAD, FACE, AWS AND TEETH 



\:\ 



EUGENE S. TALBOT, M.I> . D.D.S. 

Woman's Medio*] College; Lec1 ireron Denta 
Ethology, Rusl Luthor <>f \ the 

i and their Treatment"; Author of " Chart of Typic 'itu- 

nal [rregularities of the Teeth"; Bonorarj President ol I 
tioo of the Tenth international Medical Congress, Berlin, l*y<i: Member 
of the American Medical Association; Member of thi 

i the Chicago Academy of Medicii 
ber of the American Dental Association; Member 
of the Chicago Dental Club; Honorary Meml 
the Odontologischen Gesellschaft, lit-rlin. Get 
many; Membre Honoraire . 
eraJe dee !>• >n1 



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ENTERED ACCORDING TO ACT OF CONGRESS 
IN THE YEAR MDCCCXCIV, BY 

EUGENE S. TALBOT, 

IN THE OFFICE OF THE LIBRARIAN OF CONGRESS 
AT WASHINGTON, D. C. 



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TO Till 

FELLOWS 01 THE I UK .m.«» \< \dkm\ 01 KEDN !M 
ITHOS1 PHILOSOPHICAL CBIUSCISMf 
MKDK \L \< IM1.N HAVE Bl STAINKD THE A.UTHOB DURING THE 

THI8 VOLUME I- KESFBI TULLT KKDii A.TED 



PREFACI 

The earlier editions of 1 1 1 * - present work irerc in oof 
growth oi researchei which tended to oppose the t< 
ralent theory (erroneous in it- deductions and vicious in 
its effects on practice) that irregularitiea of the teeth and 
jaws were the result of local, not constitutional conditions 
The increasing volume of evidence against .this th< 
has forced the author to extend the -cope of hia original 
inquiry into departments of oral and nasal medicine, and 
lurgery of the eve. ear and face, bo intimately related to 
dental 'medicine through the causation originally assigned 
for irregularities of the teeth and jaws. The all 
causative factors in the case of the nose and mouth were 
themselves often found to he of constitutional origin. 
The scope of the researches presented in this edition. 
therefore, while seemingly extended, are practically con- 
fined to the limits of the original inquiry. 

The author desires to acknowledge hia indebtedness to 
Drs. J. G. Kiernan, Richard Dewey, H. M. l>anni>ter and 
James A. Lydston for valuable suggestions. Illustra- 
tions. Figs. 77. 78, 7: ( . BO, Bl, B2, B9, 90 and 91, are 
taken from the work of Zuckerkandl as reproduced by 
Bosworth (Diseases of the Nose and Throat . 

EUGENE 8. TALBOT. 

125 State Street. CHICAGO. Maw h L894. 



IAI-U I OF CONTI NTS 



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Bt» 'i OGl «»i I 1:1:1 01 LABI ITES OF mm M will l 

\M» Tl 1 I II 

Si PERNUMEB kBl III Ml 

Till Mi; -i I KING \ND Simii \u CAUSES 
Km in m«>\ <>r TEMPOS \i:y TEETH 

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A rTRIBU l i:i» i" Cn hi/ \m«>\ . 

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Want of Pi:- >pobtiom Between Jaws lnd Teeth 



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CHAPTEB III. 

I\ 1 ERMIXTURE or R \< l> .... 



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CHAPTEB IV 
Hereditary [nfluence . . . . 



CHAPTEB V. 
Development of the Cbanium and Fa< i 



i:. 



CHAPTEB VI. 

Development of the Jaws . . . 






K.\ donation "i" nii: Crania 

Mouths of Living Persons Lateral Dlameteb 
Antebo-Postebiob Dlameteb 

Height of Vault 



s 

71 



X TABLE OF CONTENTS 

CHAPTER VII. 

PAGE 

Development of the Vault 84 

Normal Vault 92 

By What Standard Shall we Measure the 

Vault 94 

CHAPTER VIII. 

Development of the Alveolar Process .... 97 

The Inferior Alveolar Process 99 

Hypertrophy of the Alveolar Process . . . 108 

CHAPTER IX. 

Developmental Neuroses 112 

CHAPTER X. 

Crime 119 

Deformities of the Jaw as Seen in Criminals . 159 

CHAPTER XI. 

Prostitution and Sexual Degeneracy 161 

Sexual Degeneracy 171 

CHAPTER XII. 

Moral Insanity, Pauperism and Inebriety . . . 172 
Inebriety 174 

CHAPTER XIII. 

Intellectual Degeneracy 175 

Maxillary Deformities among the Insane . 178 

CHAPTER XIV. 

Neurotics 181 

Neurotic Cases 186 

CHAPTER XV. 
Genius 189 



rABLE OF CONTENTS \ I 

(II LPTEB XVI. 

[DIOOI I'.'l 

Anv >i:m \i i ^ Mi \i'i D I h. u>> 

CHAPTEB XVII. 

Ni i i;i 1 1\ r. DEGENERATIVE, SPINAL AND E< •« \i. RsVEB 

8I< »\ \i. Ti:\i»im [Efi 207 

CHAPTEB XVIII 

Cons lngi on n i >f Pares re 

CHAPTEB XIX. 

In ikmi'I i;\\< IE 214 

CHAPTEB XX. 
Maternal Impressions 218 

CHAPTER XXI 
City VERSUS COUNTRY LlPE . . 221 

CHAPTER XXII. 
Constitutional Lesions 227 

CHAPTER XXIII. 

Neuroses of Development <>f the Bones op the 

Head and Face 231 

CHAPTEB XXIV 

Neuroses and Compensatory Development of the 

Bones of the Nose 251 

CHAPTER XXV 

Neuroses of Development of the Antrim . . . 281 



Xll TABLE OF CONTENTS 

CHAPTER XXVI. 

PAGE 

Neuroses of Development of the Boxes of the 

Orbits 294 

Ocular Affections Ascribable to Deformity 
of the Orbits 296 

CHAPTER XXVII. 
Neuroses of Development of the Bones of the Ear 300 

CHAPTER XXVIII. 

Neuroses of Development of the Jaws of Appar- 
ently Normal Individuals 302 

CHAPTER XXIX. 

Neuroses of Development of the Maxillary Bones 304 

Development of Inferior Maxilla by Exercise 306 
Asymmetry of the Lateral Halves of the 

Maxillary Bones 308 

Asymmetry of the Maxillary Bones . . . . 313 

Asymmetry of the Rami 315 

Asymmetry in the Body, and Improper Occlu- 
sion 316 

Imperfect Occlusion 320 

Protrusion of the Inferior Maxilla . . . . 321 

CHAPTER XXX. 

Neuroses of Development of the Vault . . . . 327 
Thumb-sucking and Similar Causes Producing 

High Vaults 328 

Fallacies of Clouston's Theories . . . . . 330 

The Vault in its Relation to Temperaments . 334 
Shape of the Vault Compared with the Shape 

of the Head 34< ) 

Mouth-breathing Not the Cause of Con- 
tracted Jaws and High Vaults 349 

Development of the Vault ....:.. 379 



I \ 1 1 1 I \ I I N I - 

( ii \n BR x\ \ , ontoii i d. 

DeFORMITI "i i 111 Suturj 

hi 1 1 -i: m i d Vaults 

Def >rmj i> Vaults Dm ro Looaj [rri q\ i lbi 

i n - oi i in Ti i i ii 

CHAPTER XXXI. 

Cleft Palati 

CHAPTER XXXII. 

Nil ROSES OF I>i:\ I I "l'Mi \ 1 OF [rBEGI I. umi ii - Ol I HE 

Tu Til 101 

The V -ii lped Abch W)l 

The Normal Arch 102 

FORM Mi« 'N OF l hi V -HAITI' Ai;i ii .... }".: 

Description of the V-shaped Arch \m> its 

Modifications 408 

[rreqi i.aim mi - i >] nil Low i i; J wv 415 

The Saddle-shaped Arch 419 

Description of the Saddle-shaped Arch \m> 

it- Modifications 4:M 

Combination of V lnd Saddle-shaped Arches . 126 

The Saddle-shaped Arch of the Lower Teeth 4:'." 

CHAPTER XXXIII. 

Local Causes of [rregularities oi rms Teeth — 

LTppeb Jaw 431 

The Central [ncisor — [rreoularities Pro- 
duced BY THE MaLP081 l [ON OF CENTRAL LnCJ 

bors Resulting from Flexion of the Alveo 

lar Pi;<m i -- 4:'.l' 

[rregularities Produced bi mi: Malposition 

of Central [ncisors IHkt<> Vicious Kkip- 

tion 

Irregularities Produced by the Malposition 
of Latera] - 4::7 



XIV TABLE OF CONTENTS 

CHAPTER XXXIII— continued. 

PAGE 

Irregularities Produced by the Malposition 
of the Cuspids 441 

Irregularities Produced by the Malposition 
of the Bicuspids 445 

Irregularities of the Teeth Produced by the 
Extraction of the First Permanent Molar . 44S 

CHAPTER XXXIV. 

Local Causes of Irregularities of the Teeth — 

Lower Jaw 454 

The Inferior Cuspid 458 

Lower Bicuspids * 460 

Migration of Teeth 461 

The Movement of Individual Teeth in 

Straight Lines 463 

Rotation of Individual Teeth upon their Axes 465 
The Forward Movement of Groups of Teeth 

and the Alveolar Process Supporting Them 465 
Anterior Protrusions from Constitutional 

and Local Causes 465 

CHAPTER XXXV. 

Supernumerary Teeth . 469 

CHAPTER XXXVI. 
Missing Teeth . . 474 

CHAPTER XXXVII. 
Thumb and Finger Sucking 476 

CHAPTER XXXVIII. 
Conclusions . . 4S0 

CHAPTER XXXIX. 
Explanation of Plates 485 



INTRODUCTION. 

The cau8atioD of deformities of the head) face, jaws ami 
teeth has qoI received the attention from scientist* which 
it- Importance demand*. Of late these deformities 
been traced to climatic changes, race intermixture, hew 
and social environment The unstable conditions of this last, 
as Bhown in commercial civilization, give rise to a tendency 
to tlif development of these conditions. The teeth, jaw- 
ami face have been variable factors in evolution, and h< 
arc most readily affected by the forces tending to degen- 
eracy. Such conditions arc easily affected by the factors 
arising out of the "struggle for existence." 

The law of the "survival of the fittest" affects do! 
only the entire organism, but also the parts themsel 
Some one part attain- undue development. Such a product 
of degeneracy once obtained might, under proper conditions, 
remain, while the rest of the body returned t<> the normal 
type. The frequency with which these Btigmata of degen 
eracy are found in otherwise Bound systems indicates that 

the law i^ atavism tend- to eradicate as well BS to cause them. 
Given these deformities in a Bubject of normal mental 
health, they simply indicate that a more or less remote 
ancestor had been subject to the influence of the factors 
producing degeneracy, hut that in the main the offspring 
were regaining the normal standard. 

The lesson to be drawn from these Btigmata i- the 
hygienic one that, given the tendency to degeneracy shown 



XVI INTRODUCTION 

in these deformities, the progress of that person under the 
factors named will tend more toward disease than that of 
the person in whom they are absent. The frequency of 
these deformities should hence have early created the sus- 
picion that they were of constitutional and not local origin, 
and should have once more taught the old, old lesson in 
medicine: that a knowledge of a man's ancestry is of great 
value in treatment. 



ETIOLOGY OF OSSEOUS DEFORMITIES 



I 1 1 1 



HEAD, FACE, JAWS AND TEETH 



CHAPTER I. 

HISTORICAL SKETCH OV THEORIES REGARDING 
THE ETIOLOGY OF IRREGULARITIES OF 

THE MAXILL.i: AND TEETH. 

SUFERNl Mil: kRl l BETH. 

Hippocrates, who lived about "»'»" b. <.. was the first to 
study human teeth, and laid down the dictum, "The more 
teeth the longer life." "The truer teeth the Bhorter life.'* 
said Aristotle about imv hundred years later. 

In 1618 Hilkiah Crooke published a work. Mi\iJoxoaf.ioy- 
u<K/>KY. iii which he gives the views of tin- beat anaton 
of his day. In this it i- observed that there are sometimes 
four and sometimes tive grinders. 

On Second Dentition the author says: "The shearing 
(t. '.. incisors) teeth, when they do break forth, do thrust the 
first shearers out before them and issue betwixt the tirst two. 
the second and the dog tooth that Lb next unto them. But if 



2 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the former teeth will not fall or be not pulled out. or if the 
latter issue before the lirst fall, then the latter make their 
way through new sockets, and turn in the upper jaw outward, 
in the lower jaw inward, so that there seemed to arise a new 
row of teeth, and this indeed hath deceived many historians 
and anatomists also." 

Barth Ruspini, in 1750, says : "All the teeth that exceed 
thirty-two may be regarded as supernumerary." He attrib- 
utes irregularity of canines and incisors to extreme narrow- 
ness of the jaws. 

Robert Blake, in a translation of his inaugural Disserta- 
tion, published in 1798, speaks of supernumerary and inverted 
teeth. 

Joseph Harris. " A Familiar Treatise on the Teeth," 1S30: 
" Irregularity is due to supernumerary teeth." 

John Winck worth, 1831, speaks of supernumerary teeth 
causing irregularity. 

THUMB -SUCKING, AND SIMILAR CAUSES. 

J. Imrie. Parent's Dental Guide. 1S3J: : " Irregularity 
is due to want of development of jaw-bones, intemperance of 
various kinds combined with artificial modes of living intro- 
duced by civilization, and sudden transition from heat to cold 
to which the teeth are subject — all these have a tendency to 
prevent development of the bones. Rabbit mouth is due to 
keeping the thumb in the mouth for hours, after going to 
sleep. Underhung jaw is due to ' sucking the tongue.' by 
throwing the under jaw-bone from its articulation. A simi- 
lar state of the teeth and jaw-bones is induced when attempts 
are made by the inexperienced to regulate them by the 
extraction of teeth in the upper jaw and neglecting to remove 
an equal number of the lower." 

J. Lefoulon, " A new Treatise of Theory and Practice of 
Dental Surgery " (translated from the French by Thomas 
Bond, 1844): "Among the causes of Dental Irregularity we 
may regard as the most frequent the neglect of proper super- 
vision of second dentition. Very often the temporary teeth 
are too precipitately removed, and again the opposite error is 



I III III \l'. I \< I . I \\\ - \N|. I I I Ml 



committed of suffering them t. the per 

manent have partlj appeared. There results from this an 
error of relation between the development of the palatine 
arch and tli«' superior alveolar border, <>r ot the two arcl 
once, relatively to the size of the teeth. Another cause is the 
bad habit of permitting children to Buck their thorn 
continually to be patting their hands into their mouths. 
Another cause is the frequently repeated action of tin- tongue 
in th«' pronunciation of certain syllables called lingual, in 
which that organ, striking against 1 1 * * - anterior superior teeth, 
gives rise to anterior obliquity of the superior arch. We 
may remark thai this deformity is verj frequent with the 
English, resulting from the pronunciation of lingual sylla- 
bles.' 1 

About the same year I>r. Thos. Ballard claimed certain 
peculiarities, such as serrated teeth and projecting jaws, to 
be the result of fruitless sucking. 

Stockton's Dental Intelli n . L845, from the " Forceps:" 
"The comparative ease by which, with pressure, the incisors 
or bicuspids may be made to alter their position, would 
naturally suggest the idea that the tongue, lips or check 
might, in Boine measure, influence their original direction; 
but as these are pressed by every one, while certain individ- 
uals only have their teeth unevenly arranged, we may look 
for some other accessory; and this may be found in the form 
of the palate, certain peculiarities of which are found in con- 
nection with similar forms of the dental arch. Irregularity 
of position is almost exclusively confined to anterior five 
teeth on each side iA' the medial line, brought about by pres- 
sure ot* tongue upon hard palate in sucking or mastication.' 1 

Nasmyth's " Researches on Development, Structure and 
Diseases of the Teeth," L845: u Projecting upper jaw is 
often the result of ;i habit ^i sucking the tongue or finger in 
infancy. But both projecting upper and projecting lower 
jaw arise from an arresl of development in the jaw when 
expansion of the arch is deficient." Be also states that we 
rind the prominent mouth in uncivilized raoi - 

The theory that irregularity may he due to thumb-suck- 



4 ETIOLOGY OF 088EOU8 DEFORMITIES OF 

ing, so much made of in modern times, was mentioned by 
different writers during the last forty years. Among these 
H. D. Ross speaks of it in 1853. At the same time he 
remarks, what must have been observed as soon as there was 
an attempt at correction, that there is greater difficulty in 
keeping teeth in position after they are moved than in mov- 
ing them. 

A. A. De Lessert, 1873, attributes deformity to fruitless 
sucking and to enlarged tonsils, which necessitate an open 
mouth. 

Thomas Salter, " Dental Surgery, "1874, attributes irregu- 
larity to hypertrophy of tongue and thumb-sucking. 

J. W. White, 1879, says that the protrusion of lower jaw 
is due to the habit of sucking the first and second fingers; the 
weight of the hand and arm causing a protrusion of lower 
jaw and teeth. 

Mr. Francis Fox, ''Irregularity of Teeth and their 
Surgical Treatment," 1880: Causes of irregularity are 
" want of proportion in the size of the teeth and jaw-bones 
or prolonged retention of temporary teeth, supernumerary 
teeth, habit of thumb-sucking or undue pressure from an 
hypertrophied tongue, or heredity." 

RETENTION OF TEMPORARY TEETH. 

Thomas Berdmore, in 1768, says that the cause of super- 
numerary teeth or a double row of teeth is due to the fact 
that the milk-teeth are never shed, notwithstanding the fact 
that the permanent teeth appear. Irregularity of teeth, is 
due to the resistance offered the permanent by the temporary, 
which also occasions snaggled, rough and indented teeth. 

Joseph Fox, "Natural History of Human Teeth," in 
1803: "Most frequent cause of irregularity is a want of 
simultaneous action between the increase of the permanent 
teeth and the decrease of the temporary ones by the absorp- 
tion of their fangs, most commonly occasioned by the resist- 
ance of the nearest temporary teeth; also from the fact that 
the permanent teeth are too large for the space occupied by 
the temporary. The growth of more teeth than the natural 



Nil HIM-. FACE, JAWfl \M> IN III 

Dumber frequently occurs, and ts alwaj b tl 
irregularity of the teeth.' 1 

Joseph Murphy, in "Natural History oi the Human 
Teeth," speaks of irregularity due chieflj to the first teeth 
Dot ha\ ing been shed in time. 

Benjamin James, in \\ Treatise on the Management oi 
the Teeth/ 1 1814, Bays: "With proper attention paid to the 
removal of the first set of teeth, the regularity of the second 
Bet may be anticipated.' 1 

Parmly, in "Lectures on Natural History and Manage 
men t of the Teeth,' 1 1 820, states that: ••Wan; of attention 
during the period of shedding the first set of teeth is great 
cause why irregularity of the teeth, and consequent deformity 
of the mouth, are apt to take place." •• When the permanent 
teeth arc large, and growth of the jaw does not proceed in a 
corresponding proportion, they are found to crowd and over 

lap each other." 

G. Waite, "Surgeon-Dentists 1 Anatomical and Physio- 
logical Manual."' 1826: "Irregularities of the teeth are 
mostly occasioned by the pressure of the temporary upon the 
permanent, throwing them in a wrong direction." 

S. S. Fitch. "System of Dental Surgery,' 1 L835; " Erregu 
larity is due to want ^\' simultaneous action between the 
increase of the permanent teeth and the decrease of the 
temporary by the absorption ^i their fangs; to the greater 
Bize of the permanent in comparison with the temporary 

"Treatise on Diseases of the Mouth,' 1 i>\ J. B. Garriot, 
L843, translated by J. \\. Savier: " Deciduous teeth, by their 
presence, often prevent the permanent teeth from arranging 
themselves in their proper position. Should we neglect to 
extract the milk teeth and other measures capable of favoring 
•d arrangement of the permanent teeth, deformity often 
very serious — may en>ue. 

QIBH >\\ in OF m win 1 . 

Hunter, in 1771, in ••Natural History of the Teeth." 
speaks of supernumerary teeth: he states that the jaw gro* - 
at the posterior edges^ and that irregularity i- often due to the 



6 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

ten anterior permanent teeth being larger than the ten anterior 
temporary teeth, while the corresponding part of the jaw is 
of the same size; therefore in such cases the second set is 
obliged to stand very irregularly." 

G. M. Humphrey made observations on the mode of 
growth of the lower jaw. He claims there is no interstitial 
growth. The five permanent front teeth occupy exactly the 
same position throughout life, and all other additional teeth 
are added to the hinder end of the jaw. This hind end is 
enlarged by the absorption of the anterior coronoid edge and 
the deposition on the posterior edge. When the molars are 
first formed they are under the coronoid process, and are 
subsequently exposed — theories proven by experiments on 
young pigs. 

SLEEPING WITH THE MOUTH OPEN. 

Tomes, in "Dental Surgery," 1859 and 1870, mentions 
the fact that deformity is caused by sleeping with the mouth 
open. He makes no mention of this in edition of 1848. 

W. Matthews, 1880, in paper read before Students' 
Society of the Dental Hospital of London, attributes irregu- 
larity to enlarged tonsils, which necessitate breathing being 
carried on with open mouth; also to heredity, maxillae being 
smaller in proportion than the teeth, which is due to the 
lessened work of maxillae and teeth by civilized races; also 
cross-breeding and thumb and lip-sucking, retarded shedding 
of temporary teeth, and too early extraction of first permanent 
molars. "Congenital V-shaped jaw is that form in which, 
previous to birth, the form of the upper maxillae is such that 
its cornua do not diverge posteriorly, but are parallel, and as 
that portion of the jaw already formed never changes its 
form, the newly-added parts will pass off in divergent lines, 
forming an angle with that previously existing, in order to 
correspond with the increasing width of the base of the skull." 

PREMATURE EXTRACTION OF TEMPORARY TEETH. 

L. Koecker, 1826: "The deformity which consists in 
shutting the under incisors and cuspidati over the upper, has 



i ill HEAD, FACE, JAWS AND TKKTII 

been produoed bj the injudicious extraction oi Borneo! the 

teeth of the upper jaw, without taking proper oare I 

a due proportion between the upper and under ja w i 

have irregularit} also when the temporary teeth are not 

extracted in time, and when we have too loi 

temporal} ■ 

Thomas Bell, "Anatomy, Physiolo<r\ un<l l)i>ea>e> of tin- 
Teeth, " 1829: "Most unusual cause oi permanent im 
larity Lb the actual wanl oi sufficient room in the jaw oi the 
ultimate regular arrangement of the teeth, and this may occur 
from disproportionate narrowness of the jaw (whether from 
original formation or produced by too early removal of 
temporary teeth) or from preternatural size of the permanent 
teeth. " 

Joseph Scott, "Art of Preventing Loss of Teeth," L831: 
11 Irregularities arise from first, a natural want of sufficient 
expansion in the jaw bone at the time of their protrusion; 
second, from not extracting the temporary teeth at the proper 
time; third, by too early an extraction of the temporary 
teeth: fourth, from supernumerary teeth." 

John Nicholles, ••Teeth in Relation to Beauty, Voice and 
Health." L833: " Deformity may be due to too Long persist 
ence of temporary teeth, or may arise from some malforma- 
tion of the teeth or jaw, entirely beyond the previous control 

Of the dentist." 

K. Maclean, •• Treatise on Human Teeth." L836: "Due 
expansion of the jaw is prevented by premature extraction of 
the temporary teeth: the permanent thereby becoming 
crowded and irregular." 

E. Spooner, "Popular Treatise on the Teeth.*' 1836: 
"First, and most frequent cause of irregularity, is a want of 
simultaneous action between the protrusion of the permanent 
teeth and absorption of the fangs of the temporary. Second 
cause is a narrowness of the maxillary arch or a want of 
proportion between the extent of it and the size of the teeth. 
Another cause is by the premature extraction oi the tempo- 
rary teeth; the jaw 18 Liable to contraction, and when the 
permanent teeth come in there will not be room in the jaw 



8 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

for them. Irregularity is also due to supernumerary teeth." 

Wm. Thornton, " A Popular Treatise on the Preservation 
of Teeth and Gums," 1836: " Irregularities of the teeth pro- 
ceed from three causes, — first, from a natural want of suffi- 
cient expansion in the jaw-bones at the time of the protrusion 
of the teeth; second, not extracting the temporary teeth at 
the proper time; third, too early an extraction of the tempo- 
rary teeth." 

Mortimer, 1836: "Irregularities arise from natural or 
accidental causes. 

"Natural causes arise from a bad conformation of the jaw, 
so that several teeth are over each other; from the teeth being 
much larger than they should be; from coming out of order 
and place; from teeth growing out of the palate or projecting 
into the mouth. 

"Accidental causes arise from neglect or ignorance in 
removing milk-teeth too soon; when the second teeth from 
some internal cause take a direction inwards or outwards; 
underhung jaw arises from making faces." 

Charles De Loude, " Surgical, Operative and Mechanical 
Dentistry," 1840: "Irregularity is due to supernumerary 
teeth, to second teeth being too large and maxillary arch too 
narrow, and to too early extraction and too long persistence 
of temporary teeth, and to shape of the maxillary arch, and 
to heredity, where the child inherits the jaw of one parent 
and the teeth of the other." 

Sam Ghimes, 1843, speaks of the underhung jaw being 
due to the upper incisors extending inwards, and on closing 
the mouth they come in contact with the lower; this makes 
the child inclined to protrude the lower jaw, which finally 
becomes habitual, and promotes the increase in the length of 
the jaw itself. 

Early French writings contain little or nothing on the 
subject. In a German work — "NesseFs Compendium der 
Zahnheilkunde," 1856 — the cause of irregularity is attributed 
to the premature extractions of temporary teeth. The alveoli, 
it is stated, form a bonescar in such cases, which is an obstacle 
to the advancement of the permanent teeth. In consequence, 



iiii HEAD, i \« i . i \\\ - \si» i i i i ii 

u is claimed, the permanenl teeth come b< fort the iw is suf 
ficient l\ expanded to receh e i hem. 

DEVED >r\n m "i SPH1 N 

J. L. Down, u Relation ol reeth and Mouth to M 
Development," L871, wrote: " Excessive vaulting ol palate, 
due to arrest ol development ol the sphenoid or defect 
growth ol vomer. The defects are developmental defects, 
and betoken a cause long anterior to the time when Bucking 
the thumb la practiced, unless that habit be an intra uterine 

(»nc." 

Mr. Oaklej Coles, "Origin and Treatment ol Certain 
Irregularities ol the Teeth," l vv l. before International Medi- 
cal Congress, said his observations in regard to intermaxil- 
lary prognathism were based <>n the authority ol Mi. Hilton. 

Dr. Oakley Coles expressed the opinion, held by others 
about the Bame time, that the best t\ pes ol English jaw give 
an equilateral triangle. He applied Greek name- t<> the dif- 
ferent classes into which he divided various forms ol arches; 
he gave no basis for his classification except that of form. H< 
attributed intermaxillary prognathism to a force original 
in the sphenoid bones and acting on the intermaxillary bone, 
and held that premature ossification of the sutures operates 
powerfully in the production of oral deformity. 

\ i i i : 1 1 -. i - 1 i i» TO On hi/ 1 1 1' >v 

J. P.Clark. **A New System of Treating Human Teeth,' 1 
[829: " Irregularity may arise from too premature extrac 
tion of temporary teeth. Disproportion between the teeth 
and the jaws may be occasioned by a natural conformation of 
the part-, or may be the unnoticed effect ^( accident For we 
seldom find any such disproportion and consequent irregular- 
ity in the teeth of men and animals in a wild Mate" 

J. L. Levison, in "Jaw- and Teeth bl Semi-barbarous 
Men." 1852: "The jaws ot civilized men are more con- 
tracted than those of semi-barbarous race-, and this is the 
result of the direct violation ol the Creator's la ws^ who willed 
that the brain and nervous system of the growing child should 



10 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

not be overtaxed, and that the dental process of attempting 
to build up the organic instruments and cultivate the mental 
faculties at the same time is a matter almost impossible to 
accomplish.*' 

In British Journal of Dental Science of 186^ an extract 
of George Catlin's " Breath of Life " is given. In this he 
states that malformations of teeth are due to keeping the 
mouth open, as civilized man is the only animal who keeps 
his mouth open during sleep. 

Mr. Mummery and Mr. Nichols made extensive observa- 
tions in 1860 on the teeth of savage races. They report that 
irregularities of the teeth and contracted jaws were rare. Mr. 
Nichols found but one case of slight irregularity among the 
thousands of Indians and Chinese which he examined. Messrs. 
Coleman and Cartwright examined a large number of skulls 
in the crypt of Hythe Church in Kent. These were very old, 
though their history is not known definitely. All of them 
had well-developed jaws and alveolar arches, and the teeth 
that were still present were remarkably regular. 

About 1864 Mr. Samuel Cartwright read an able paper 
before the Odontological Society of Great Britain. In this 
he expresses his views that irregularities result from selective 
breeding; that they are both congenital and hereditary; that 
there is very little increase in the anterior part of the jaw 
after eight or ten years; that if the temporary teeth were to 
remain the jaws would not change from those of childhood; 
that in all cases of irregularity the maxillae are more or less 
altered in proportion of development, whilst the teeth main- 
tain, in regard to their size, an average development. 

Mr. Hepburn, in "Irregularities of Teeth and Their 
Treatment," 1870, says: "Contracted maxillae and alveoli 
are the result of artificial life and other causes attendant on 
civilization. Ethnologists affirm that with the advance of 
civilization, there is decrease in the size of the facial and 
maxillary bones." Deformity is also attributed to cross- 
breeding. 

Among comparatively recent works on irregularities, that 
by Kingsley on '* Oral Deformities " is one of the most im- 



I ill III \l>. FACE, JAWS AND TEKTII II 

portant He attributes irregularities chiefly to premature 
extraction of temporary teeth, intermarriage between pel 
of different nationalities, hereditary or disturbed inni 

( ON81 in [TONAL ■ \i -i - 

John Fuller, 1810, attribute* laritj to too long per 

sistence of temporary teeth; he also says that the upper jaw 

is too -mall tor the permanent teeth, which fact often < 
sions irregularity. " Some children have the habit of pro 
inir the nnder jaw forward, and, of course, shutting one or 
more of the under trout teeth beyond the upper, which Boon 
becomes permanent. " 

Mr. Sigmond, in u Treatise on Disease and [rregularities 
of the Teeth and Gums," 1825, attributes irregularities to — 
1. natural: 2, accidental causes. " Natural, (1) when they 
result from the jaw not expanding sufficiently to allow the 
teeth to form a regular circle: 2 when they are larger than 
the ordinary dimensions; (3) when they do not appear in 
their proper order and place. Accidental, when caused by 
negligence or improper treatment at the time of their growth.' 1 

Andrew Clark, u Practical Direction- for Preserving the 
Teeth," L825: "That irregularity of the teeth is occasioned 
by want of room in the jaw. and not from any effect that the 
first set produce upon them, is evident because, in all c 
of irregularity, we find that really there is not room to admit 
of placing all the teeth properly." 

William Robertson, "A Practical Treatise on the Human 
Teeth." L841, Bays: "Deformity is due to inheriting the 
contracted jaw of one parent and the large teeth of the other.' 1 

Savier's translation of F. Maury's "Dental Art" 1842: 
"Prominence of upper jaw is due to narrowness of the arch: 
— ion, due to the anterior teeth." 

C. A. Harris, u Principles and Practice of Dental Sur- 
gery,' 5 L845: ,, An infringement of law- of growth or dis- 

*The terms '•attributed to civilization" ami "constitutional C 
used by the author in order to harmonize the views held 
and those of the author. Hy this arrangement the student can comprehend the 
actual causes more readily. The terms used bj the author are explain) 
chapter XXXI. 



12 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

lurbance of the functional operation of any of the organs of 
the face or head may determine an improper development of 
the jaw and a bad arrangement of the teeth.-' He also men- 
tions supernumerary teeth and irregular individual teeth; he 
attributes irregularity of the teeth to the narrowness of the 
maxillary arch, and sometimes to the presence of temporary 
teeth. 

Arthur, "A Popular Treatise on Diseases of the Teeth," 
1845: ''Irregularities of the teeth may proceed, amongst 
others, from three principal causes: First, the presence of a 
greater number of teeth in the mouth than is natural; second, 
a deficiency of space in the jaw; third, a wrong direction given 
to one or more at the time they make their appearance. A 
deficiency of space may arise from a contraction of the jaws 
in consequence of the too early extraction of the temporary 
teeth; from some original malformation of the jaw, or from 
a great excess in size of the second set over the first." 

W. K. Brideman, 1845, "On Causes of Irregularity of the 
Teeth," denies the aid of the tongue, lips or cheek in in- 
fluencing the teeth from original direction; but attributes it 
to shape of the jaw. 

Sam Harbert, 1S47: Irregularities of teeth are due to 
premature extraction of deciduous teeth and protrusion of 
permanent before the absorption of a deciduous fang. A 
projection of lower jaw is attributable to neglect in second 
dentition; generally it is supposed to be due to elongation of 
the jaw, which is almost always an error. When the dental 
arch becomes contracted at the medial line, giving to the 
mouth a pointed appearance, it is often the result of prema- 
ture extraction of certain of the temporary teeth. "Practical 
Treatise on the Operations of Surgical and Mechanical Den- 
tistry." 

Alfred Canton, 1851, "Teeth and their Preservation:" 
"Irregularity of teeth, as regards their shape, position, 
direction, crowded condition, etc., are met with more fre- 
quently than is supposed to be the case. Causes are chiefly 
mechanical, depending either on the non-increase in size of 
the jaw in proportion to the growth of the teeth to be con- 



1 111 111 mi. i \< i . i w\ - wi» 1 1 i i ii i:; 

tained in the alveolar arch) on the | »* >—it i< >ii of the permanent 
teeth with reference t<> the fangs of their | »i » - 1> am I 

lastly, on the increase in size <>f i jaw in preference to i h< - 

other.' 1 

u Treatise on Second Dentition, 9 ' bj U. F. Delabarre, trans 
lated for American Journal of Dental v u Malcon 

formation of denture ma\ be occasioned, first, by a defect in 
the conformation of the jaw; second, bj the simple want of 
their development depending upon the health <>f the indi- 
vidual; third, by an excess in the development of all the 
teeth, though the jaws are in other respects well formed; 
fourth, by rapid development of the dentition of one set and 
delay in thai of the other; fifth, finally, by the too great size 
of the teeth of one jaw, which do not harmonize with those 
that are opposite." "Some forms of defective palatine 
arches are hereditary." 

J. R. Duval, kt The Youth's Dentist:" "In a projecting 
chin the alveolar arch, in which the incisor- and canines are 
placed, ha- taken a development upon a parabolic line. 
greater and more prominent than that presented by the body 
of the hone: this differs very little from a similar one in 
upper jaw. which projects over the lower. Upon attention 
to shedding of temporary teeth depend- the tine arrangement 

of the lower." 

Dr. Gunnel], in American Journal <>r' Dental Science, 

-tate- that protrusion of lower jaw is in many cases here 
ditary; hut often i- brought about in this way — the incisors 
of the Lower jaw are cut first, and when the upper ones make 

their appearance the lower have nearly arrived at their full 
growth. In closing the mouth they come in contact with the 
gum on the inside of the upper incisors, and for relict* the 
lower jaw i> thrust out. which soon becomes permanent." 

Samuel Cart wright, Jr., in lecture delivered before King's 
College, reported in British Journal of Dental v . in 

June, L857, says, the u irregularities of permanent teeth are 
due. first, to non-absorption of the root- of temporary teeth 
in proportion to the rise of those of replacement: second, the 
great difference which commonly exists in the size of the new 



14 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

teeth as eompared with those of the first set; third, contrac- 
tion of the arches of the jaws and other malformations of 
maxillary and palate bones, originating in hereditary, con- 
genital and other causes." 

A. A. Blount, "Orthodontia," 1866: "Remote causes 
which produce irregularity will be found in the commingling 
of all nations, with national and individual characteristics. 
Most frequent causes are the result of accident, indiscriminate 
extraction of the deciduous teeth and too early extraction of 
permanent teeth." 

H. Sewell, "Irregularities and Diseases of the Teeth," 
1869: "Protrusion of incisors is due apparently to an 
abnormal development of premaxillary bone. " Irregularities 
are due to "retention of temporary teeth, causing permanent 
teeth to assume an unnatural position, also to malformation 
of jaw, which are usually congenital and at the same time 
hereditary: may, however, be due to injury or other acci- 
dental causes." 

WANT OF PROPORTION BETWEEN JAWS AND TEETH. 

David Jobson, "On the Teeth," 1834: " Irregularity is 
due to smallness of maxillary arch and great size of 
permanent teeth and their situation, part on inner and of 
others on outer side of temporary teeth." 

John Mallan, "Practical Observations on Physiology and 
Diseases of the Teeth," 1835: "Now, the adult teeth being 
larger as well as more numerous than the milk-teeth, it is 
obvious that they require a great deal more room, and when 
the absorption of the latter does not progress equally with 
the growth of the former, the new teeth are crowded up and 
are apt to be forced out of their natural position by the 
resistance of the old. Again, if the permanent prove, as 
they sometimes do, disproportionately large in comparison 
with their predecessors, the jaw may not be sufficiently 
extended to admit of their being arranged in regular order, 
in which case some overlap the others and considerable 
deformity is occasioned." 

Paul Goddard, "Anatomy, Physiology and Pathology of 



i hi 111 \i>. PACE, JAWS AND TEETH I • 

the Teeth,* 1 I v 1 1 1 H Most prolific cause of irregularity ia the 
w.ini <»t room in the dental arches this arises sometime* 
from b congenital defect, but more eommonlj from earl} 
decay and I"-- of the temporary teeth, which failing to 
up the alveoli, enables the jaw to contract and thus afford too 
little room for the permanent Bet." 

The author, after Bevel) years of constant Btudy and scien 
tific research, in a paper read before the Dental Section oi 
the Ninth International Medical Congress in i sv 7. entitled, 
"Etiology of Irregularities of the Jaws and Teeth," called 
attention to the following points: 

1. The peculiarities in the eize and shape of the jaw bone 
may be inherited, but the manner of the eruption of the teeth 
cannot be transmitted: that is, irregularities of the dental arch 
j» /• 86 are not inherited. 

2. That the muscles of the cheeks have nothing to do 
with the production of the V or saddle arch. 

3. That the only tissues involved are the jaw hour on the 
one hand and the teeth and alveolar process upon the other; 
and in L888 (see Dental Cosmos), by diagram, he showed how 
the different deformities were produced. 

4. That the incisors in the V-shaped arch always pro 
trude; in the saddle arch, never. 

5. The manner of the formation of the V and -addle 
arches in the arrangement of the teeth. 

6. No matter what position the teeth may take, the 
alveolar process is dependent upon the teeth for it- -hape and 

position. 

7. He showed the difference between thumb-sucking 
deformities and those of the V and -addle areli. 

In the same paper on ■* Arrest of Development and 1 
>ive Growth of the Maxillary Bones," the author called atten- 
tion to the fact that the jaws would become arrested and execs 
sively developed from constitutional diseases in the follow- 
ing words: "The Last, but not least, of the causes of arrested 
development of the maxillary hone-, which I -hall mention, 
is that due to constitutional diseases and the eruptive fevers. 
Debilitating acute diseases (fevers, the exanthemata), inchil- 



Id ETIOLOGY OF OSSEOUS DEFORMITIES OF 

dren are sometimes followed by sudden overgrowth of bone, 
which is quite noticeable. This process affecting the jaw, 
may account for a certain proportion of those cases of measles 
and pneumonia which are followed by dental irregularities 
and maxillary deformities. In some cases, however, the pro- 
cess is a low grade of inflammation, which is followed by 
atrophy of the jaw, instead of hypertrophy or hyperplasia.'' 
In a paper read before the Section of Dental and Oral 
Surgery of the American Medical Association, at Cincinnati, 
May 8, 1888, the author first classified the irregularities of 
the teeth into, (1) constitutional, those which develop with the 
osseous system; (2) those due to local causes; (3) resume 
2 " Irregularities of the teeth cannot occur until they have 
erupted and thus shown their relation to each other and to 
the jaw." That is, the deformity commences at the sixth 
year and is completed at the twelfth year. By diagrams the 
author has explained how the forward movement of the pos- 
terior teeth would produce the same result as arrest of devel- 
opment of the maxillae. Although the jaws were sufficiently 
large, the result of the forward movement would be to develop 
a V or saddle arch; hence the necessity of keeping the first 
permanent molar in its normal position. (In 1888, first edi- 
tion of Irregularities of the Teeth.) In 1889, the author read 
a paper before the American Dental Association, Saratoga, 
New York, on " The Classification of Typical Irregularities 
of the Maxillae and Teeth," the result of a collection of over 
two thousand models, and an examination of a thousand more, 
in the collections of Dr. Farrar, of New York, and Dr. Shep- 
ard, of Boston, and others in different parts of this country 
and Europe, making in all over three thousand. This classi- 
fication was V, partial V, semi-V, saddle, partial saddle, semi- 
saddle, semi-V on one side and semi-saddle on the other. In 
1889, a paper was read before the Dental Section of the Amer- 
ican Medical Association, at Newport, R. L, June 25 th, 
entitled, "Statistics of Constitutional and Developmental 
Irregularities of the Jaw and Teeth of Normal, Idiots, Deaf 
and Dumb, Blind and Insane Persons." In 1890, second 
edition of Irregularities of the Teeth; in 1890,' a paper read 



i 111 ill IAD, PACE, FAWS \m> I I i I h IT 

at the International Medical I Berlin, "The Diffei 

entiation of Anterior Protrusion oi the Upper Maxilla and 
Teeth;" in 1891, u Mouth Breathing not the Cause oi ( 
tracted Jaws and High Vaults.' 1 He showed bj a large aum 
ber of measurements and aotual cases in | that the 

vault was not contracted 03 mouth breathing; thai con 
tracted dental arches were as common among low vault 
high; thai thej -imply looked liiirli because of the contrac 
tion; thai mouth breathing due to hypertrophy of tin- bones 
of the nose and mucous membrane, deformities of the nasal 
bones, adenoid growth and any pathological condition that 
would produce Btenosis, <U>r> not pr<»du<r the contracted jaws, 
but that all of these conditions are due to neuroses of develop 
ment. 



CHAPTER II. 

CHANGES IN CLIMATE. 

Man, in his development, must or should be studied as an 
animal, and from two great standpoints, because of the 
structures involved. First, the nervous system, and, second, 
the osseous or bony system. The changes that take place 
resemble the moulding of a human being in clay. If we 
watch the sculptor as he prepares his figure we perceive at 
first how ungainly and ungraceful it appears, but as he adds 
pieces of clay in one place and removes them from another, 
we see developing a most beautiful piece of art. Just 
as the changes take place in the model of clay, so greater ones 
take place in man. Having accepted the Darwinian theory, 
let us call the uncouth model the orang and chimpanzee: 
then as the figure passes through its various changes until it 
becomes a thing of beauty, so man, in his vicissitudes, rises to 
what we might call a perfect being. 

We have now the framework upon which to build; the 
brain begins its development, and we find the osseous system 
built out at one point, reduced at another, just as the clay 
model was moulded. The animal which formerly possessed 
only instinct now begins to reason and to think for himself. 
When he depended upon nature for his subsistence he had no 
need for reason; now, through the various changes of climate 
and conditions, he begins to collect material for shelter and 
protection, and to cook his food. 

The development of the nervous system is accomplished 
at the expense of the osseous system. Thompson says:* 
' ' The structure of the face arose from' its parts having been 
created for the accommodation of the speech and sense organs, 
and upon these foundations the facial features were con- 
structed and facial expression became possible. The inverte- 
brate animals have the special sense organs scattered over the 

*Dental Cosmos, 1890, pp. 633, 683. 

18 



Nil HEAD. I \< I . JAWS AND TKKTII 19 

entire body, bo that there is ivalh no fan*, strictly -«» call.d, 
until we reach the vertebrates, where the face andsp 
Bensesare located within a limited area upon the front of the 
bead." 

In the animal depending upon it- physical strength for pro 
tection and food, the bony framework is verj strong. The 
bones are Large, long, and the attachment of the muscles 
marked, thus indicating the muscular strength. Ascending the 
scale to man. the bones are -mailer in diameter and Bhorter, 
Bhowing that the muscles are not bo large or strong. Like 
changes also take place in the shape of the head, face, jaws 
and teeth, and since man is no longer compelled to procure 
his food with his teeth or protect himself with his jaw-, the 

jaws and teeth heroine -mailer and change their shape. The 

brain is constantly enlarging and changing its -hap.-, and the 
bones of the head, particularly the parietal and frontal, 

expand forward, laterally and upward, while the temporal 

muscle, zygomatic arch and jaws decrease in Bi'ze. 

In comparing the jaws of the orang and chimpanzee with 
that of the negro, we find a great difference in the size, 3hape 

and character of the teeth: and in comparing the negro jaw 
with those of the working classes, and the latter with thoa 
the well-to-do class, who do not perform physical labor, there is 
as great a change as in the case of the orang and the negro. 
The changes are the result of the law of compensation. The 
human race has to develop in an intellectual line; to seek a 
higher plane and brain development without any or with lit 
tie physical training. The result is a fully developed brain and 
a weak physical structure, which Boon succumbs to death. 
[n the preparation of the food of the present time mastica- 
tion seems totally unnecessary, and arrest of development of 
the jaws and early decay of the teeth, with a weak physical 
frame, result. In comparisons of the Bhapeof the head, face 
and general appearance of the people of the present time 
with those of our ancestors, it i- plainly evident that the 
human race is improving in grace, beauty and intellect, while 
the changes in the general outline of the head, face and jaws 
in a few generations are very marked. 



20 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

It makes no difference what views the reader holds in 
regard to the origin of man; we shall observe from facts 
which we have been able to glean here and there, that there is 
a gradual change in the structure of the bones of the face and 
jaws from the earliest race to the present time, and frequently 
we observe retrograde metamorphosis. As we look upon the 
different shapes of the head, face, and jaws of different nation- 
alities, as well as of the people of one nationality at the present 
time, we must admit the fact that great changes have taken 
place in past generations, and that changes are still going on. 
The changes that are going on around us in almost every- 
thing, such as occupation, modes of living and dress, are 
much greater. Three of the greatest factors, however, which 
influence the changes are, change in climate, intermixture of 
races, and hereditary influences. 

Taking this classification in order, w T e have first, change 
of climate. It is a well-known fact that climate has a great 
influence over the inhabitants of a country and their customs, 
both physically, intellectually and morally. The earliest 
races were a people among whom a physical degeneracy was 
seldom found. They had a nomadic tendency, consequently 
in journeying from one country to another, there was a 
mingling with foreign races, (the latter of which I shall 
speak more fully on in another chapter) and the various 
changes of climate from extreme cold or hot, and vice fjersa, 
have at last formed an entire new race. I can do no better 
at this time than to quote Dr. Quatrefages: '* The human 
species springing originally from a single center of appear- 
ance is now universally distributed. In their innumerable 
travels, its representatives have encountered the widest 
difference of climate and the most opposite conditions of life, 
and now inhabit both the polar and equatorial regions. It 
must, therefore, have possessed the necessary aptitudes for 
accommodating itself to all the natural conditions of exist- 
ence; in other words, it must have had the power of becom- 
ing acclimatized and naturalized in every place where we 
meet with it." 

Certain monogenists have held that a human race could 



l III III \l>. I \< I . i \w - Wh l l I l II 21 

not effect a change oi extreme climate without the I" 
life, while others maintained exactly opposite opinion \ : 
.nix rate, we know that manj races have passed these two 
extremes, but it causes .'m entire change in the structu 
the offspring, both In man and beast as well bjb fruit 
vegetables. We know that the wool of - 1 1* «*| » i- different in 
each state of the United States, anil an expert wool dealer 
can tell bj the feeling from what part of the country or what 
Btate ii ha- come. The same changes take place with the 
lit'LT. In Russia, the hoi: has long, -till', rough bristles with 
soft ends and long root-, with a large amount <>t' wool inter- 
mixed for the purpose of keeping the animal warm. The 
color i- gray, black, yellow and white. In Germany, the 
domesticated hog has Bhort, slightly rough bristles with 
-mall roots. The color is gray and black. The French hog 
ha- Bhort and Boft bristles with very little wool. The color 

i- white and yellow. In India, the bristles are short and 
-till, intermixed with long hair with split end-: the root- are 
rough and large. The hog of China ha- -mooth. medium 
length bristles with no root-, and the color i- Mack. In the 
Southern part of America, the wild hog ha- -till" l>ri-tle-: in 
the North, the domesticated hog ha- .soft bristles. The color 
i- black and white. It ha- been asserted that horses kept in 
the deep coal mines of Belgium become covered with a soft 
velvet coat not unlike that of a mole, while the change in 
cattle, dogs and birds i- perceptible i«> all. hut the change 
that take- place in man is equally a- great. 

The negro, perhaps, has undergone the most remarkable 
changes Bince being brought to the [Jnited State-: hi- physi- 
ognomy is changed entirely. Keclus Bays: "In the -: 
of 1 50 years they have passed a L r <><»d fourth of the diet 
that separate- them from the white race, a- far a- external 
appearance goes," while Quatrefages declares that a t% sub- 
negro race has been formed." Bowever, they -till retain 
some of their ancestral characteristics, conformed to the 
effect of climate and associations. We notice this even in 
tlie colored people of the Northern and Southern Btates. In 
the South we rind him still under the influence of Blaverv, or 



22 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

rather, the effects of bondage. There are a great number who 
are thrifty, well-to-do and educated, but the greater number 
still remain in ignorance, are lazy, and take on the character 
and manners of the poorer class of white people. This is due 
in a great measure to the high temperature of the country. In 
the North, where the temperature is lower, nearly all the 
colored people are educated and occupying good positions. 
The theory has been advanced that this is due to the colder 
climate arousing the people to activity. In the Irish people, 
we find the broad, massive jaw changed to a delicate one like 
those of the Americans. This is also true of the Swede and 
Norwegian, while the teeth of the Scandinavians decay almost 
immediately on their arrival in this country. This has been 
proven as due to the change in climate, as well as of diet. It 
has been well proven that Frenchmen can live perfectly well 
in Corsica, only they must avoid the Eastern coast marshes, 
which even the natives themselves cannot inhabit. 

Every race being a resultant whose components are partly 
the species itself, partly the sum of the modifying agencies, 
has produced deviations from the original stock. This is in 
accordance with nature's laws, that still further modifying 
causes produce conditions differing from any that the race 
has known before, thus changing types in a very marked 
degree. 

The pilgrims, who braved the storms of the ocean and 
landed on Plymouth Rock, would doubtless have remained in 
obscurity had they still continued to live in the Old World, 
but instead they founded a country which at this time com- 
pares with any on the globe. Through their bravery in with- 
standing the winters upon the bleak and barren coast of New 
England, and also the fortitude with which they bore the 
hardships and trials of life, they have won an everlasting 
fame. Had they landed upon any other point than in New 
England, in all probability the foundation principles of the 
Constitution of the United States or the Declaration of Inde- 
pendence would never have been written with such fore- 
thought or decision. 

These people and their direct descendants- stood , by and 



i in HEAD, i M i • fAWH \m» i i i i m 

protected the infant republic, first from the depredations oi 
the red man and second from the -till greater power of l 
land. 

Manv years ago, irhen the government surveyors had 
finished their work in Minnesota, the} reported to the author 
ities in Washington, 1>. C n among other things, thai it 
impossible for human beihgs to live the whole year in thai 
Btate, owing to the extreme gold in winter; now not only do 
people live and cultivate the soil throughout the entire si 
but a large citj has sprung up still farther north, and the 

country around has become well populated. 

In a lecture, delivered by the late Benry Ward Beecher, 
after an extended tour of this country, he -aid that the re| 

Bentative men of this country would come from tin- North 

west He believed thai the climate and its various changes 
would develop a race which would be unequaled anywhere 

in America. I can well remember fifteen year- ago when 
emigrants were unable to obtain a living throughout the 
middle and western part of Kansas, owing to the drouth. 

The soil would not yield crops, tree- would not gTOW, and 

fruits and vegetables could not be cultivated. Now the Btate 

ia well populated; the finest fruit- and vegetables are raised; 
the country is well watered, and prosperity is noticed upon 
every hand. A> a marked illustration of the effects of climate 
upon people, we have only to look at the prosperity and 
growth of some of our Western cities and town-. The 
inhabitants are made up of people from every climate. The 
Spaniards. Italian- and Greeks from the balmy shores <>i the 
Mediterranean, the white and negro from the sunny South, 
are all transformed from their indolent habit-, become 
enthused and rush on to keep pace with their brother from 
the colder North. In many cases this is due to the sudden 
changes in heat and cold, and these changes in climate fre- 
quently produce suffering and even death. 

It has been a disputed question among anthropologic 
well as doctors as to the possibility of acclimatization of 
Europeans in the archipelagoes of the great Mexican Gulf. 
A number of sreneral f. lrl . M . ( . m t .» leave no doubt but that 



24 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the answer should be in the affirmative: but the yellow fever 
and its influence appear to be particularly fatal. The reader 
must not mistake my meaning to be that the Europeans can- 
not live on these islands, for they have occupied them since 
the discovery of America, but the climate seems to be more 
fatal to them than in any other part of the New World. The 
white race has brought the negro to these islands, and in the 
course of time they have replaced the Carribean race; but 
though these islands are among the most favored spots on the 
globe for emigration, yet the race if left to itself would almost 
entirely disappear. 

The structure of the osseous system of individuals changes 
greatly. I do not mean those who have attained their 
growth, but the children taken to the new country, and those 
born there. For instance, when Europeans settle in America, 
their bodies and limbs become elongated. In all probability 
this is due to the dryness of the atmosphere causing more 
evaporation. Observe the stature of the American Indian; 
the great development of their bones and limbs is the result 
of abundant food, a temperate climate, and roving habits in 
a wild country. 

Some authors assert that climate does not cause the differ- 
ences in the races, and that the intermixture of races causes 
the difference. We all know that intermarriage has a great 
influence, but climate, while, if it has not a greater influence, 
is at the same time one of the prime factors. It is the climate 
more than any one thing that has made the Aryan of India 
so different from the Aryan of Persia. 

We all know that the people who live in the limestoue 
regions develop larger osseous systems than those of other 
parts of the country, and also people who live in places sup- 
plied with water from artesian wells develop large-framed 
men and women. 

A change of climate and soil, in cases of long illness, is 
nearly always beneficial, when made at the proper time, 
especially in case of people with weak lungs, and arrest of 
development of children as a result of constitutional diseases. 
The effects of climate upon the individual either tend to build 



I ill III \i». I \< I . FAWfi INI) I I l i ii 

up or break down the general system of those who have 
obtained their growth. In Bach cases the osseous system is not 
changed materially; but it is in the young children brought 
into iiif country, or children born of parents who have em i 
grated, thai the genera] changes take place. 

Thus we see that climate and soil li.i\ I influent 

tlu* inhabitants of :i country. 



CHAPTER III. 

INTERMIXTURE OF RACES. 

In the preceding chapter we have shown that man from 
the earliest times was a traveler. He had the same desire to 
explore unknown regions and to mingle with strange people 
that he has today. 

Let us assume the fact that previous to 300 years ago the 
races did not mingle as they do now. Also, the tribes 
and races that did come together did not present such a 
marked contrast in appearance. 

In the early times the people made only short voyages 
along the coasts in rudely constructed vessels, of which the 
caravels of the Spaniard and vikings of the Norseman are 
good illustrations. These vessels could not withstand the 
heavy seas and high winds of mid-ocean, and even in many 
cases the winds and rains which swept along the coast doubt- 
less carried some poor ship down; so that emigration by water 
was almost nothing, and hence nothing was known of distant 
countries or races; but the question arises, was it any better 
by land? The people in their journey over mountains and 
plains, through barren tracts of land, many of their com- 
panions a prey to wild beasts, while oftentimes whole cara- 
vans were destroyed by the fierce torrid winds of the desert, 
overcame these great disadvantages, and though it took many 
hundreds of years, and at last populated European countries 
and produced the various types of man now found. 

We must date the commencement of emigration, as well as 
the discovery of the New World, that was eventually to pro- 
duce the marked changes that constitute the new races, to 
Columbus. Very little, however, was accomplished in this 
direction in this country until a century later, when the 
mixture of blood became very conspicuous, as the result of 
the conquest of the Indies, Mexico and Peru, 1515-1534, and 
still later the landing of the Pilgrims, 1620. 



I ill HEAD, FACE, JAWS wi» i i i i ii 

In the nineteenth century we find thai intermixtu 
races and emigration has gone on to such an extent thai ire 
sometimes stop and ask the questions, what -hall we <-:ill this 

new race that ha- BprUDg up. and i- there a pure race <>n the 

irloi>e at tin- present time. A- regards the first, it has never 
been answered satisfactorily; for the second, let us tak< 
illustrations the Jew-. Chinese an. I Japanese. I think I am 
quite -ate in saying that these are the only pure races. Of 
course, some few of these have intermarried, but the oat 

a- a whole arc almost entirely pure. 

The great emigration and intermixture are due t<> the 
inducements of liberty in religious beliefs, labor, high waj 
liberty a- opposed to oppression, and the desire of the people 
for better conditions and comforts in new countries, in con- 
trast to the crowding and scarcity of work in the old coun- 
try. 

Traveling long distances by sea and land ha- brought 
together nations of the greatest possible differences in opin- 
ion-, modes ot li vim:-, and peculiarities in the structure of the 
<»--e,» ii- system. 

Each country has it- peculiar type of people. Africa it- 
negroes, America its tribes of Indians. Japan and China their 
own particular people, and throughout Europe, the white 

races, each indigenous to it- own country; but how different 
and marked are the changes in the osseous system. This has 
been nicely illustrated by Prof. Putnam in his collection on 
anthropology at the World's Fair, showing conclusively that 
the marked changes are in the size and shape of the hone-. 

When a race has lived in its own country, without change 
in habits or mixture with other races, there i- no reason t<> 
expect a change in its type. 

The Egyptian is a good example of this. In comparing a 
picture taken from Kanie-e- II, about 3,000 year- ago, 
with the Egyptian of today, we can discover little or no 
change. The Ethiopians on the early Egyptian bas-reliefs 
have their counterparts among the white Nile tribes, while 
we recognize in the figures <»f the Phoenician or [sraelite 
captives, the familiar dew of our own day. This illustrates 



1 >S ETIOLOGY OF OSSEOUS DEFORMITIES OF 

conclusively that a race may keep up its special characters 
plainly recognizable for over thirty centuries. 

One of the most conspicuous examples, and the one most 
familiar to all English speaking people, is that between the 
negro and the white race. The mulatto complexion and hair 
are intermediate between those of the parents, and new grades 
of complexion appear in the offspring of the white and 
mulatto, the latter being known as the quadroon. The inter- 
mediate character in all race mixtures, however, has a ten- 
dency to revert to one or the other parent in a more or less 
degree. Referring again to the colored people for example, 
we see that here the offspring presents all the characteristics 
of the mixed race. Some of the children may resemble the 
white father in color, but have the features of the mother; 
rarely do we find two children whose parents are one white 
and the other colored, that have the same color, or whose hair 
is the same. The greatest change, other than color, is the 
hair. The mulatto's hair is an intermediate between the 
short, crisp, woolly hair of the negro and the hair of the 
white man. When mulattoes marry into their own race — that 
is, the colored race — in most cases their offspring will take on 
the full negro type, but if a mulatto marries any other race, 
the offspring rarely has any of the negro features; sometimes, 
however, they will revert to their negro ancestors. 

A mixed race invariably arises where the races inhabit 
the same district, and within the last few centuries it is a 
well-known fact that a large fraction of the world's popula- 
tion has actually come into existence by race-crossing. This 
is more evident on the American continent than elsewhere, 
for such districts as Mexico, which, since the Spanish con- 
quest, has become largely populated with descendants of 
Spaniards and native Americans. The intercrossing of races 
has given anthropologists a w T ide field in the endless shades of 
diversity among mankind. It is a hopeless task even to 
classify each group into a special race. The difficulty of 
making a systematic assignment of each man to his particu- 
lar race is well illustrated among the Arabs. There is a class 
of them who speak the Arabic tongue, are Moslem but not 



1 111 MEAD, PACE, i\»^ ^ N i' i i i i ii 

Arabs proper, neither are the} Egyptians ot the old k 
dom, but of a land where the Nubian, Copt, >\ rian and 
.,,-,,, have mingled forages; hence their ancestry maj 
have come from three quarters of the globe. 

[n India, a variety of complexion and feature is found 
which cannot be classified bj race exactly, bul we must 
remember the distinct varieties of men who have contributed 
to this dense population, the dark brown indigenes, or hill 
tribes, the Mongolians from the frontiers of Thibet, together 
with the fair Aryans or Endo Europeans from the Northwest, 
and this mixture going on for ages has produced numberless 
crosses. So in Europe, the fair nations of the Baltic and the 
darker nations of the Mediterranean by their crossing have 
produced an indefinite diversity of brown hair and interne 

diate complexion. 

Heterogeneous races have by intermixture given rise to 
raceless masses, people which present no fixed characters, and 
who form, >o t«» Bpeak, dispersive circles around the original 
Bpecies, which at their points of contact become confluent* 

Pure races exhibit a more uniform type, and the mixed 
races a variegated type, and this variation increases as the 
intermixture increases. + 

When we hear of a people which, despite a low state of 
intellectual culture, exhibits a variety in features, nose, lips, 
as for instance among the Tschuvashes, we shall not be wrong 
in considering it as of mixed origin. 

The Samboes, descended from an Indian and negro, in the 
south of the United States, present sometimes crisp hair with 
copper-colored skin, and all other Indian characteristics, and 
sometimes the coarse hair of the Indian upon the head of the 
negro, with a black skin. There is here no intermediate type 
produced by intermixture, but there is produced an irregular 
agglomeration of the characteristics ^^ the parent form-. ; It 
might be demonstrated that these different races, the people 
of Northern Italy. Southern Germany. Great Britain, not to 



* Vogt. 

\ Wait/.. "Anthropology. 

J Ibid.; Forey on Schoolcraft. 



30 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

speak of the United States, where the fusion of blood is prob- 
ably inexplicable, have given birth, by their intermixture, to 
ethnological modifications still recognizable. In all these 
countries the instability of anthropological characters is in 
contrast with the fixity which marks pure races. • 

The union of different nationalities is more common in 
this country than in any other; due, no doubt, to the fact 
than people of all countries and nationalities Hock here to 
better their condition in life. We would expect that marriages 
would naturally result from a commingling of these foreign 
elements, especially in the newer parts of the country. Immi- 
gration of different nationalities, and intermarriages which 
take place, tend to improve the race physically in some 
respects, and in others degeneracy results. Inasmuch as the 
tendency in this country is toward the production of small 
jaws, while the jaws of foreigners are much larger, the off- 
spring of such marriages would naturally inherit the extreme 
peculiar characteristics of both parents. Such peculiarities 
are very noticeable in the tribe of Marshpee Indians on Cape 
Cod. The present people are descendants of the original 
Indians, who married among the whites, negroes and Portu- 
guese. These intermarriages have continued down to the 
present generation, making seven or eight generations in all, 
until, as Professor Putnam, of Harvard College, has said, 
" there is very little Indian blood left." There are, however, 
three or four of the older people who still retain all the char- 
acteristics of the early Indian race. It is very interesting to 
observe the peculiar features of the younger generation, a 
few of which I will describe. A little girl, eight or ten years 
of age, presented all the peculiarities of the negro, — broad 
nose, thick lips, dark skin, with the long, straight, black hair 
of the Indian, reaching nearly to her waist. Another, Mrs. 
H., whose mother is half white, father negro; she is full 
negro in appearance, except the skin, which is copper col- 
ored. The jaws are slender in outline, and quite unlike the 
father's. Mr. K., great-grandfather, negro; mother, Indian; 
father, three-fourths Indian. He has large jaws like the 

* Broca, " Hybridity in Genus Homo." 



i 111 HEAD, FACE, JAWS AND TEETH 81 

negro; long, straight hair, copper-colored -kin. hiL r li cheek 
hones. Mr. IV. maternal grandfather, Portuguese; paternal 
grandfather, negro; paternal grandmother, Indian and white; 
maternal grandmother, [ndian and negro. II< has finecurlj 
short hair, negro nose, high cheek bones, Large jaws and 
teeth, upper and lower teeth occlude. I could give from mj 
note-book many other illustrations of these marked changes 
in bone structure, and also peculiar mixtures, produced by the 
union of different nationalities, but enough has been said in 
regard to this tribt to show that \\ hen there is a union of 'lit' 
ferent nationalities, the offspring inherit not only the peculiar- 
ity of one parent, but frequently possess a mixture of the 
peculiarities of both. A similar class of people, made up oi b 
union of Indians and negroes, is Located in South Carolina, 
and called by the people " Red Bones." They have been thus 
described in an interview with Senator Hampton: "They 
live in small settlements at the foot of the mountains, and 

oiate with none hut those of their own race. They 
resemble in appearance the gypsies, but their complexion is 
red. This intermixture, which is common in the Carolina-. 
produces marvelous results. It takes the kink out of the hair 
of the African, strengthens his features, and improves him in 
every way except in temper." 

These inherited peculiarities do not cease at the first gen 
eration. hut are transmitted to at Least the seventh or eighth 
generation, as I have shown in the cases of the Marshpee 
Indians. It would seem that, from these oases, rare peculiar- 
ities under favorable circumstances might be carried on inde- 
finitely. There is B tendency on the part of these Indian-, 
due no doubt partly to the mixture of white bloodand partly 
to the soil, climate and environment, to take on the general 
make-up, as regards the osseous system, of the native white 
people, but far as my investigations went. I was unable to 
observe the high vault, irregularity of the teeth, and the 
neurotic condition BO noticeable among the native white 
people. While they possess the same facilities for schooling, 
they lead a very quiet life of farming, fishing anil outdoor 
work generally. The trades, professions, and such Lines of 



S'2 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

work arc not sought after, and hence neurotic conditions are 
not found. 

The improvement of the " Red Bones'* over the negro 
by "straightening his feature-." mentioned by Senator Hamp- 
ton, must necessarily consist of a change in the bones of the 
face. These changes must be brought about by the union of 
the negro with the Indian, producing children not unlike 
those already mentioned in connection with the descendants 
of the Marshpee Indians. Americans are all familiar with 
the changes that have taken place in the features of the 
negro, due to their consorting with the whites. The lower 
jaw of the children diminishes in size from generation to 
generation, and the anterior lobes of the brain increase pos- 
teriorly, the vertical portion of the frontal bone assuming 
more of a right angle with the horizontal portion. In this 
manner the octoroon and quadroon acquire in many cases 
beautiful features. 

That mankind was already divided into a few great main 
races, in remote antiquity, will go far to account for the 
innumerable slighter varieties which shade into one another. 

In speaking of the mixed races which come to this 
country, we must not lose sight of the fact that the neurotics 
and degenerates of all the countries of the world either come 
here from the great inducements offered or are exiled, and 
when they intermarry with our own population, the result is 
a native class of degenerates made up of all the deformities 
of the brain and osseous system that are known to civiliza- 
tion. As early as 250 years ago this class of the degenerates 
settled in Pennsylvania, Virginia, but more particularly in 
Georgia. The result of the accumulation of paupers and 
degenerates has flooded the country and lowered the standard 
of mankind. As will be found in another chapter, this taint 
has crept out in otherwise respectable families. 

What we have found to be true of the people of this 
country is also true of our English cousins. Here we find 
the deformities more marked than in this country, or even 
among ihe other nationalities of Europe. 

In prehistoric times, and even as late as the Roman Con- 



I 111 III \l». FACE, i kV - \M> I I M H 

quest, the Datives of Britain were a race of imm< are 

It baa been stated t li.it captives taken to Rome were the 
tallest people in tin- ent ire oitj . 

( )f all the races of Europe the English are, perhaps, the 
most mixed. The Bnglish maj be considered as a race result 
ing from the intermarriage ol the Angles and Saxons with 
the native inhabitants of the British [sles prior to the Saxon 
invasion. According to Prof. Buxley, Britain waa popu 
lated by a dark and a fair race. The dark race, resembling 
the Iberians, inhabited the western parts, while the fair r 

mbling the Belgian Gauls, the eastern districts <»t the 
island At the time of the Roman Conquest the languagi 
Britain was wholly Celtic, but the Land was -till in the poa 
session of the two races. Subsequent invasions failed to alter 
the relation of these stocks, though they spread a third wave 
of language Teutonic over the entire Celtic-speaking area, 
leaving only traces of the old tongue in Wales, Ireland, S 
land and [sle of Man, About the fifth century after Christ, 
the Angles and Saxons invaded Britain and mingled with the 
( teltio-speaking inhabitants, who. together with the few remain- 
ing Romans, peopled Britain. Then, the first invasion of ( rreat 
Britain by the Normans and Danes during the ninth, tenth 
and eleventh centuries added to this blood, already 30 mixed, 
another foreign infusion. Figuier, in his "Human Ra 
aays: "The level plains, which areasa rule met with in England, 
are not favorable to the development of the lower extremities, 
and it is a fact that the power of the English lie- not so much 
in the legB as in the arms, shoulders mid loin-. The ti-t i- 
an Englishman's natural weapon, either for attack or 
defense." The changes which have taken place in the size of 
the jaw- between the early Britons and Bnglish people of the 
present day are of the most marked character. By actual 
measurement of the superior maxilla, from the outer Burface 
of the first molar upon one side to the outer surface of the 
other, there is a difference of .32 of an inch, showing that the 
jaws have been gradually growing Bmaller. If the measure- 
ments had been taken from the outer Burface of the second 
bicuspids a greater change would have been noticed, because 



34 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

of the fact that degeneracy of the jaws takes place anterior to 
the first permanent molar. 

Anthropologists claim that in the earliest history of the 
world man was divided into two great classes — brachy- 
cephalic, or broad head, and dolichocephalic, or long head. 
There is a difference of opinion among anthropologists as to 
what constitutes a broad or long head. Broca's division is 
perhaps the most authentical. He gives five divisions, as fol- 
lows: 

True dolichocephalic. - below 750 

Sub-dolichocephalic, - - 750 to 778 

Mesocephalic, - - 77^ to 800 

Sub-brachycephalic. - - 800 to 833 

True brachycephalic, - above 833 

While Professor Flower, of the Royal College of Sur- 
geons, England, simplifies this table by the following: 
Dolichocephalic, - - below 750 

Mesocephalic, - - - 750 to 800 

Bra chy cephalic, - - above 800 

These measurements are obtained by dividing the extreme 
breadth of the skull by the length from front to back and 
multiplying by 100. The general subdivisions, as given by 
anthropologists, are: the black race, dolichocephalic; the white 
races, mesocephalic, and the yellow races, brachycephalic: 
the Lapps, brachycephalic. and the English, mesocephalic. 
while the Xorth Germans are sub-dolichocephalic, and the 
South Germans sub-brachycephalic. 

It is not the intention of the writer to discuss the antiquity 
or the classification of these different types of man. That 
they did exist very early in the history of the world is 
amply illustrated by the specimens that have been exhumed 
in different parts of Germany and England, and are to be 
seen in the different museums throughout Europe. 

From the earliest history down to the present time these 
two types have intermingled, and are to be seen to a greater 
or less extent among all the nations of the world. The 
tendency seems to be for the dolichocephalic, or long-headed 
race, to merge or change into the brachycephalic. or broad- 



1111 III M>. I \« I . JAWfl WO I I I I II 

headed people, although the evolution of the brain would at 
first contradiot this Btatement. The evolution of the brain 
has developed anteriorly by a gradual pushing forward of 
the frontal bones. The original, or pure African, type repre 
Benting tin- lowest form of man. shows now quickly in the 
colored race the changes from the dolichocephalic t-» the 
brachyoephalic have taken place by changes of climate and 
int. rmixture «>t' races. The dolichocephalic, or long-headed 
t\ pe <>t tin- African, ha- changed during the past t wo or three 
generations t<> a mesooephalic ami brachyoephalic. 

Upon tin- examination of about 2, colored people in 

Chicago, I have been unable t<> find but -i\ \\ li< > posse 
dolichocephalic heads. The others were mesooephalic and 
brachyoephalic, with their modifications. This tends to show 
that changes in climate and intermixture with the Indian and 
white races have completely changed the Bhape of the head as 
well as the entire physical Btructure of the African. The 
Budden changes in type art- not confined to this race, hut are 
found among some o\ the New England families. This leads 
mc to believe that these sudden changes in type could take 
place in the Bhape of the head from dolichocephalic, and 
- in any family under similar conditions in any part 
of the world. A- we have -ecu. marked changes in the shapes 
of tlie head result from change of climate and mixture of 
races; the shape of the jaws must necessarily change to cor- 
respond with the Bhape of the head. 

The changes, which occur in the genera] outline of the 
head and jaws in a few generations, are excellently illus- 
trated in the following portraits of a noted family in this 
country. Four generations are here shown, in the order in 
which they lived. Tin- cuts are drawn from daguerreotypes 
and photographs, and of course arc useful only in iri\ inu: the 
genera] outlines of the shapes of the head-. Unfortunately, 

the hail' upon tin 1 face- depicted in the last two illustrat 
forbid- an\' comparison being made BO far as the jaws are 
concerned. There i-. however, Buch a contrast in the shapes 

of the heads that those who are familiar with craniology can 

readily trace the changes which would naturally take place 
in the shapes of the jaw-. 



36 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



Fig. 1 represents a man born in Connecticut in 1761; died 
in L826. This picture represents a dolichocephalic head with 
massive jaws, prominent lips, especially the upper. The nose 




Fig. 1. 



Fig. 2. 





Fig. 3. 



Fig. 4. 



I III III \l>. 1 \( I . .1 \\\ - Wll 1 1 I I II 

is long, .-mil the eyes are Bet close together; the forehead verj 
high and Btraight. 

Quite :i change is noticeable is the second generation, 
depicted in Fig, •_'. The faoe is not bo long, the lateral diam 
eter of the head is larger, the forehead more prominent, and 
the eyes arc a little farther apart. The nose is about the 
Bame length, and while there is a general resemblance about 
the mouth and chin, the distance from the front of the chin 
t<> the tip i>i the nose is not quite bo long. The change 
Beems to be in the shortening of the chin. 

3 shows still further change. The forehead is broader 
and less retreating than either. There is perceptibly less 
prognathism. There is less prominence in the supraorbital 
region. 

Fig. I -hows a head ju>t the opposite of Fig. I. This is 
a brachycephalic head. The head is nearly round; forehead 
full; eyes Bet in the head to correspond with the width of the 
head: nose broad; upper lip short, and lower jaw much 
broader than in Fig. 1. The lower jaw is evidently much 
shorter in a perpendicular line. These changes air due to a 

protruding forehead, receding Chin, and delicate features. 

We have Been by these cuts that in four generations 

shape- of heads have entirely changed. It is possible that Un- 
reverse changes from brachycephalic to dolichocephalic 
might take place, hut I am of the opinion that the long 
headed races are gradually becoming extinct and the broad 

headed race taking their place. 

Anthropologists are familiar with the changes that take 
place in the jaws, corresponding to the changes in the head. 



CHAPTER IV. 

HEREDITARY INFLUENCE. 

It is not the intention of the author to say more than a 
few words upon the subject of heredity; so much has been 
written that it is useless to enter deeply into the subject. It 
will only be attempted here to give a few facts pertaining to 
heredity in general, thus bringing the matter more vividly 
before the reader; but later on heredity as relating to the 
special study of the cranium, face, nose, jaws and teeth will 
be discussed. 

Anthropologists agree that heredity is that influence 
which foreordains that the offspring shall be in the likeness 
of the parents. This is Nature's great law, and it is uni- 
versal from the lowest forms of vegetable and animal life to 
man. 

It is marvelous what an extent the hereditary influence of 
each of the parents has over the offspring, with such dif- 
ferent characteristics, however, that it is almost impossible 
to speak of both in the same terms. Each individual is 
single or simple in one aspect and composite in another. We 
seem to inherit bit by bit, or piece by piece, this element 
from one parent, that from the other, until an intermediate 
individual is formed. These elements, however, are liable to 
some small changes during the process of transmission. The 
child receives life from his parents, and with that life takes 
up a certain estate of moral, mental, and physical characters. 

The inheritance of a trait of bodily figure, character or 
action is a mystery as great as the apparently sudden change 
in a race, which for many generations has produced a seem- 
ingly unchanging succession of attributes — bodily, mental or 
physical. 

Peculiarities of structure, however, possess a double 
interest, both of variation and persistence. Science has as 
yet failed to find the cause of these peculiarities. They 



I 111 III \l». I \( I . I \\\ - \M» 1 I I I II 
appear in :i fa mi I \ , from w li;it BOUT06 n»> 0D€ kn< >w -. and I hen 

t lu\ remain as hereditary traits, inherited intermittently 01 
regularly, We shall be able, in the studj of tl and 

teeth, to Bhow quite olearlj h» >\\ modification in structure 
handed down from parent to child. 

Heredity i- often dependent upon climate, soil and inter- 
mixture of races. While children are inclined to inherit 
parental qualities, yei the tendency is eventually to develop 
a race like Lhe Indigenous stock referred to in the chapter of 
climate. In other words, climate and soil modify the dif- 
ferent generations to Buch an extent that in the period of five 
to ten generations the offspring will assume the outward 
appearance and also the habits of the people with whom they 

ate. 

In an area of a tew hundred miles in Europe, we find 
the Italian-. Germans, French, Spaniards, Russians and 
Bohemians, each with different feature-, customs and modes 

of dres-. In the same area in the Tinted State-, the native 

Indians of the several tribes, have the same different char- 
acteristics in feature-. Transport a French colony to Russia, 
the future generations will conform to Russian type (though 
they do not intermarry); that is, they will assume the Russian 
customs and habits through climate, soil and associations. 
In the United States, these same conditions would take place, 
if the Penobscot Indian- of Maine or the Marshpee Indians 
of Cape Cod had emigrated to the western country. In this 
case, however, the changes would he more marked. In the 
course of two or three generations, the long, slim individual 
would become more like the short, thick-set individual of the 
Sioux or Manitoba tribes, and their peaceful nature would 
change to the character of the ferocious Apache or Crow. 

This is al-o nicely illustrated in comparing the inhabitants 
of today of the Eastern, Southern and Western states of the 
United States and the negroes of the South with those of the 
North. The people differ in features, speech and mod< 
living nearly as much a- if they resided in different countries. 

Owing to the fact that tin- greater part of the United 
State- has only been lately developed, and emigration date- 



40 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

back only about one generation, and to the intermixture of 
different nationalities, the fixed types, which are so marked in 
Europe and among the different tribes of American Indians, 
are not observed to such an extent, but the transformation is 
slowly going on. Nisbet says: "If a Latin-Spanish colony 
settled in Germany, and remained there, we are bound to 
believe they would eventually conform to the German type. 
The influence of the physical surroundings steadily exerted 
would gradually overcome that of heredity, although the pro- 
cess might occupy thousands of years. Thus we see that 
heredity and physical conditions work together in the mould- 
ing of a race.'* 

The Jews, from an hereditary point of view, are also inter- 
esting. They inhabit even' country of Europe, and though 
they frequently intermarry, and differ greatly in physical 
characteristics, still any Jew can be told by his nose, which, 
according to Nisbet. "'is as much a matter of heredity 
as the thick lip of the Imperial House of Austria/' The 
German Jew differs from the Portuguese or even the Spanish 
Jew. Each may be of pure Jewish blood, but he conforms in a 
more or less degree to the type of the people with whom he 
associates. The hair and complexion are mainly affected, 
but the expression and shape of the features are everywhere 
significant of Jewish blood. Victor Cherbuliez has said that 
"every country has the Jew it deserves," and to my mind 
this must be partially true, for Jews that have lived for gen- 
erations under free goverments are not so apt to be as treach- 
erous and unreliable as those who have lived under despotic 
governments. The English and French Jews make better 
citizens than those living in the eastern countries of Europe. 

Hereditary peculiarities are both natural and acquired. 
By natural conditions we mean those that are of a physical 
nature, while acquired conditions are those that come to us 
through habit, association or accident. De Quatrefages says: 
"The acquired nature is, so to speak, welded to the original 
nature of the being." 

It is of the natural conditions, however, that I wish to 
speak most in this chapter. They are everywhere noticeable; 



i 111 HEAD, i \« i . JAWS AND mini II 

sometimes n< >t appearing until late in life, yet the} are right h 
to be called natural, unless the} are extremelj ezoeptional or 
have never previously appeared in ti fnniiU ; even it \ 
i>\ some ancestor, the) would -till be hereditary and natural. 
Galton says: u Natural peculiarities are apparently « 1 1 * * - t < ► 
two broadly different causes; the one is family likeness and 
the other is individual variation.' 1 These seem to be much 
opposed to each other and to necessitate a separate discussion, 
yet the reader ran readily understand 1 1 » » \\ the offspring can 
possess a general or even an individual likeness to it- parents 
and at the same time have a large amount of individual dif- 
ferences. Ihu-. to my mind, family likeness and individual 
variation arc dependent upon ca»h other, each being different 
effects of the same cause. Some variations are, however, bo 
remarkable that they appear to belong to a separate class. 
We shall be able to Bhow, in a future chapter on Neuroses of 
Development, why these marked differences exist between 
the child and parent. 

A number of -mall accidents tend i<> produce variations 
in the different members of a family: therefore it i< almost 
impossible to enumerate the qualities of an individual from 
hereditary data, hut we can predict the average results with 
great certainty. 

The possibilities of inheritance do not differ much more 
than the varieties actually observed among the members of a 
large family. We may have the Life-histories of parents and 
relatives and also the offspring. In comparing them, we find 
that each one'- life seems to run apparently in the same line: 
that is, the offspring from generation to generation will have 
some characteristics of hi- ancestors. 

Perhaps there i- no one thing that i- inherited more 
directly than disease. 

Family history often -hows that twoand three generations 

have died from inherited diseases, and then again it will pass 
over one generation and appear in the next. The inheritance 
of insanity, and co-existing diseases of tin- brain, have about 

the same direct per cent that lymphatic disease doc-: yet. 



42 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

lymphatic disease, as an hereditary trait, "dies out,*' as we 
say, much quicker than insanity. 

A good example of this is found among the royalty of 
Europe. Even as far back as the Caesars we find this taint, 
beginning with Julius, though during the entire reign of the 
Caesars Roman society was so corrupt that the family may 
even be considered a model one for the times. But let us 
now observe the royalty of England, beginning with the 
Plantagenet period. According to Jacoby, the rival houses 
of Lancaster and York were both degenerate, the former 
being a family of imbeciles, and the latter, to use a strong 
term, villains. The deformed moral imbecile, Richard III, 
nicely illustrates the villainous nature of the family. The 
Tudors were somewhat similar. Henry VII was an epi- 
leptic, and the morbid features of Henry VIII and his chil- 
dren are familiar to every reader of history. Insanity of 
the Stuart line dates from Mary Tudor, and was inherited 
through Mary, Queen of Scots, by James I of England. 
We shall return to Elizabeth and her successor's reign later, 
and now follow the direct Stuart line. Nisbet speaks thus of 
the Stuart line: "Charles I was perfidious and cowardly; 
Charles II, depraved, epileptic and without lawful issue; the 
brother of the latter, James II, was treacherous, epileptic 
and vindictive, mendacious, cruel and ridiculous to boot; 
Mary, daughter of James II, was weak-minded and childless, 
and hence a prolific neurotic, and not a healthy or long-lived 
family. Finally, Charles Stuart, the pretender, the last of 
his line, was illiterate, dipsomaniac, paralytic and died 
insane." But, to return to the Stuarts: several of the chil- 
dren of Elizabeth died young, and it was through her 
younger daughter, Sophia, who became heiress to the throne, 
that the Hanoverian line was established, and the question 
arises, did she bring this taint to the throne ? For an answer 
we must look at the careers of the Four Georges. In George 
III, however, the insanity of the Stuarts re-appeared. From 
the Georges on, the occupants of the throne of England, 
according to Bismarck, are the u crazy and scrofulous 
Guelphs," among whom are bleeders, epileptics, hysterics 



I ill ill \i>. i \< i . 9AWI \M' i El i ii 

:m< I other neurotics, and the taint is -till observed at the p 
cm day. History but repeats itself In the royal famili< 
Spain, Germany, Austria and Russia. 

I have mentioned the lives <>f the-.' royal families, with 
the names of which we are at least all familiar, toshovt that the 
taini of insanity, and its modifications, is inherited from gen 
♦•ration to generation tor hundreds of years; out tin- common 
inhabitants of the world arc not exempt from this taint. It 
Bhould be noted that the great causes of insanity and its modifi 
cations arc the result of idleness, drunkenness, debauchery, 
and consanguineous marriages, and that the consequences <-t 
these conditions area weak physical structure in the progeny, 
which results in early death or insanity, drunkenness, <-pi- 
lepsy, deafness, mutism, blindness, idiocy, egotism, genius 
and brilliancy. 

1-Vw will deny that what i- true of the whole organism is 
equally true of its different part-, organs, functions and ener- 
gies, and that in the formation of a new 1 xinir. the action of 
heredity is divided into a- many varieties as there are char- 
acters to be transmitted. There i- a tendency on the part of 
each parent to reproduce itself in the child, and consequently 
there i- a constant Struggle between the two natures in the 

morphological growth of the child. The more dissimilar the 
parents, the greater the struggle, and the more certain the 
predominance of leading characteristics, and the greater the 
tendency to morphological abnormalities, arrest or excess of 
development. The outcome of this Btruggle, assuming 
inequality of action on account of one parent being stronger, 
is a number of single combats in which one or the other of 
the parent- is vanquished. 

Differences of opinion of scientists have existed for many 
years as to whether acquired peculiarities are capable of 
inheritance. Some of the latest writers upon this subject 
claim that they are not inherited, but even Wei—man. the 
strongest opponent of the inheritance of acquired qualities, 
has to admit the inheritance of epilepsy, and Bimer has Bhown 
that Wei — man's admission in the case of epilepsy must, on 
Weissman's own principles, be extended to other ncur< 



44 ETIOLOGY OF OSSEOUS. DEFORMITIES 

In a future chapter it will be shown, by actual demonstration, 
that peculiarities of structure, which are known to be the 
result of constitutional diseases, are inherited by the suc- 
cessive generations. 

Children may resemble their parents in habits, manners, 
customs and disposition, yet be wholly unlike them in 
structure as far as the features are concerned, though the 
physical structure may be the same. The effect of habits 
and manners of parents on the offspring is very striking. 
It is usually said that boys assume the habits of the father 
and girls those of the mother. This may be or is so from 
association. 

Such peculiarities as stammering, lisping and the like 
may seem to some scientists as referable to a special class of 
hereditary traits, but it appears to me that this cannot be so, 
and that they are acquired habits. In my own experience I 
have known children who both stammered and lisped either 
because they heard one or the other of their parents or play- 
mates do so. This class, I believe, may be termed neurotic 
individuals. Neurotic qualities of parents are often inherited 
by the child, who becomes the victim thereby of contending 
mental states. 

I have purposely referred to inherited neuroses and 
degeneracy in the royal families of Europe, because in the 
chapter upon Developmental Neuroses we can more easily 
understand why deformities of the face and jaws are noticed 
in otherwise apparently healthy individuals, as well as in 
idiots and feeble-minded. 



CHAPTER V. 

M.\ ELOPMENT OF THE CRANIUM AND I \< I 

[nearly Btages of development the posterior pari of the 
cranium is large in proportion to the anterior part. At about 
the second month of festal life the parietal region begins to 
increase rapidly in volume along with the greater develop 
ment of the cerebral hemispheres; the frontal region next 
begins to increase in Bize, and toward the latter part of foetal 
life the occipital region increases as the brain extends back 
ward. The face at birth is in surface about one-eighth of 
the cranium, while in the adult it is fully one half. 

At birth the face still show- peculiarities which resemble 

those of the foetus. The car- arc much lower than in the 

adult, the external opening being but little above the mouth. 
Racial distinctions arc not at all pronounced, the children of 
the most Btrongly marked race- Bhowing great similarity, 
according to the law that the farther hack we go in develop- 
ment the more generalized arc all the features. 

After bilth there are three distinct period- of develop 

ment, the first ending at about the seventh year, the second 
at about the fourteenth, and the last at about the twentieth 
year. 

The transition from the first to the second type is quite a 
striking one. The skull grows rapidly during the first seven 
year-. By that time certain part- have reached their definite 
size: the circumference of the occipital foramen, the body of 

the sphenoid, the cribriform plate of the ethmoid, and the 
petrous portion of the temporal hone. The eruption of tern 
porary teeth, the gradual modeling of hones by growth, the 
development of mu-cular prominence- and depressions grad- 
ually change the infantile character of the physiognomy. 

The face becomes Longer in proportion to it< width, and 
the jaws arc shaped with reference to use in mastication. In 
the second period very many of the forms are already adult. 



46 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

and, if not at their fullest development, have very nearly 
approached it. From six to twelve the growth is somewhat 
slow. With the approach of puberty a second period of 
active growth begins. This period especially affects the face 
and frontal portion of cranium. With this we also note the 
expansion of the frontal and other air sinuses. From four- 
teen on there is very little advance in cranial development. 

The face becomes elongated in the process of growth, 
partly by the increased height of the nasal fossae and the adja- 
cent air sinuses, partly by the lengthening growth of the 
alveolar process and the enlargement of the jaws. 

The base of the skull, together with the face, increases 
relatively in size from birth onward; the skull as a whole, in 
proportion to the face, decreasing. 

The bones of the face are developed by the intramem- 
branous ossification, with the exception of the symphysial 
portion of the inferior maxilla. The nasal bones are each 
developed from a single center in the membrane overlying 
the fronto-nasal cartilage. This center is seen in the eighth 
week of foetal life. At birth the nasal bones are nearly as 
wide as they are long, but in the adult the length is three 
times greater than the width. 

The malar bones each ossify from two centers, which 
appear also in the eighth week. 

The superior maxilla arises from four centers, termed the 
pre-m axillary, maxillary, malar and pre-palatine, which 
appear about the eighth week, and ossify rapidly. 

The portion of the bone which lodges the incisor teeth 
arises from the pre-maxillary nucleus. The nasal process 
and the greater part of the body arise from the maxillary 
nucleus. The portion of the bone external to the infra- 
orbital groove arises from the malar center, and the nasal 
surface and part of the palatine process arise from the pre- 
palatine center. 

The inferior maxilla has six centers of ossification for each 
lateral half. 

These centers, all but the splenial, are deposited between 



I Ml III \l>. I \i I . I \W ^ \\|, | | | | || J; 

tin- sixth and eighth weeks. The splenial appears about three 
w eeks later. 

At birth the inferior maxilla consists of two lateral halves, 
which unite during the firsl year; union, however, is oof com 
plete until tli«' Beoond year. The most striking features of the 
skull a1 birth are its relatively I in comparison with 

the body, and the predominance of the cerebral over the 
facia] portion of the skull. 

The origin of the structural points, which constitute the 
permanent expression of the head and face, as we have alreadi 
said, i- to be studied from the standpoint of evolution. 

The uoim IS of the head and face arc shaped and clothed 

with flesh according to the action of past and present influ- 
ences. The present influences are the present need-, sur- 
roundings and habits oi' the individual. The past influences 
shape the embryo, and mark the infant with a likeness to its 
parents. After birth the hereditary impulse carries on the 
development of the structures through the nervous system. 
The types of the parents and ancestors are mingled and modi- 
tied by present circumstances, such as climate, food, habits 
of thought and action. 

EI !>. Cope, in his article on "The Development and Sig- 
nificance of Human Physiognomy," has brought together the 
following statements in regard to the changes in the face and 
head of man during his evolution from an animal to a civi- 
lized being. 

The point- to i»e considered in the structure of the head 
and face are as follow-: 

1. Relative proportion of cerebral and facial regions. 

•_'. Prominence of forehead. 

Prominence of superciliary ridg 






4. Prominence of alveolar borders. 
Prominence and width of chin. 

6. Relation of length to width of sku. 

7. Prominence of t lie malar hones. 

8. Form of nose. 

9. Relative sizeof orbits and eyes. 
10. Size of the mouth and ! 



48 



KTIOLOGY OF OSSEOUS DEFORMITII> <>F 



Changes in the above points are traced from previous 
conditions of man by the study of paleontology, and by the 
study of the development through the embryological exist- 
ence. In comparing the human head and face with that of 
he order Quadrumana, we notice the following general dif- 
ferences in the shape of the head and face. Numbers corre- 
spond to the list above given. 

1. In the ape the facial region of the skull is large us 
compared with the cerebral. 

Forehead not prominent, generally retreating. 
Superciliary ridges more prominent. 
Edges of the jaws more prominent. 
Chin less prominent- 
Fig. 5. 



3. 
4. 

5. 




A— Front view. B— Side view, after Cope. 

Cheek bones are more prominent. 



Nose without a bridge, cartilages short and flat. 
Orbits and eyes smaller (except in Nyctipithecus). 
Mouth small; lips thin. 
Should any man possess any of the above characteristics, 
he, in feature, becomes more like the monkey, as he retains 
features which have been obliterated in others of his species 
in the process of evolution. 

In studying from an embryological standpoint, we must 
consider the head of an infant at birth. (Fig. 5.) 

1. The cerebral part of the skull greatly predominates 
over facial. 

3. Superciliary ridges are not developed. 

4. Alveolar borders are not predominant. 



i 111 HEAD, FACE, JAWS AND TEETH I'' 

g, NoSC i- without bridge, and caitila^CN arc ihtl and LT< 

♦-in 1 1 \ short 

:'. \'.\ efi are lai ger. 

[t is evident that the possession of these characteristics in 
adults Bhow them to be infantile in that respect, and their 
absence Bhows that the} have been obliterated in reaching 
maturity . 

In reviewing the characteristics of the monkey and infant, 
we find the following point- in common: 

8. The nose without bridge, and cartilages short and flat. 

The following points are found to be different: 

1. Facial regions of skull larger as compared with the 
cerebral. 

2, Forehead not prominent. 

£. Superciliary ridges arc more prominent. 

\. Edges of Ihe jaws arc more prominent. 

It thus becomes apparent that as man develops from 
infancy he becomes more like the apes in some important 
parts of his facial expression. But it may also be noted that 
there exists the same difference between the embryonic and 
adult monkey and the embryonic and adult man. The 
change is greater in degree in the monkey than in man. 

The following is quoted verbatim from Professor Cope: 
" Man Btops short in the development of the face, and is inso 
far more embryonic. The prominent forehead and reduce. 1 
jaws of man are character- of " retardation. " Bince it is B 

Buperaddition to the quadrumanous type from both the 
standpoint- of paleontology and embryology. Thedevelop- 
ment of the bridge of the nose is, no doubt, directly con 
nected with the development of the front of the cerebral pari 

of the skull and ethmoid hone, which, sooner or later, carries 
the nasal bones with it. 

If we now examine the leading characters of the physiog- 
nomy of three of the principal human sub Bpecies- the negro, 
the Mongolian and the Indo-European— we can readilj 
observe that it is in the two first named that there is a pre- 
dominance of the quadrumanous features which are retarded 
in man: and that the embryonic characters which predomi- 



50 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



nate are those in which man is accelerated. In race descrip- 
tion the prominence of the edges of the jaws is called prog- 
nathism, and its absence orthognathism; as compared with 
those of the Indo-European, is as follows: 

Negro— Nose flat, without bridge (quadrum. retard.): 
prognathous fquadrum. accel.); malar bones prominent (quad- 
rum, accel.); beard short (quadrum. retard.). 

Mongolian— Jaws prognathous (quadrum. accel.); nose 
flat or prominent, with or without bridge; malar bones 
prominent (quadrum. accel.); beard, none (embryonic). 

Indo-European— Jaws orthognathous (embryonic retard.); 
nose (generally) prominent with bridge (accel.); malar bones 
reduced (retard.); beard long (accel.). 

The Indo-European race is the highest by virtue of the 
acceleration of growth in a well-developed nose and beard. 
It is superior in those points in which it is more embryonic 
than the other races, viz., the want of prominence of the jaws 
and cheek bones, since these are associated with a greater 
predominance of the cerebral hemispheres and greater intel- 
lectual power. 

Some people are always partially embryonic in having a 
short face and light lower jaw. Such faces are still more 
embryonic when the forehead and eyes are protuberant. 
Retardation of this kind is frequently met with in children, 
and less frequently in women. The brain, or nervous system 
as a whole, holds direct supervision over the formative process 
going on in the face and cranium. We find at birth the 
brain relatively large and its growth rapid. During the first 
seven years of life the brain attains to nearly its whole size 
and weight, ninety per cent, in fact. The remainder of its 
bulk (about ten per cent) is added very slowly. According 
to Boyd, and others, after the age of fourteen the increase is 
very slight, scarcely perceptible, and after seventeen or 
eighteen, there is none; but from my own investigation, 
after the age of eight, the brain slowly develops. The cells, 
however, are constantly taking on new energy and resistive 
power. 

The shape and form of the face depends principally upon 



I iii in \i>. PACE, JAWS AND TEETtJ 51 

the bony Btruoture. Hie bones oi the cranium are developed 
I,, form a convenient protection to the brain, and thej 
Bhaped accordingly; the brain, expanding In the prefrontal 
territory, directly shapes its bonj case to fittherequiremet 
We see the shape oi the oranium depending directlj <>n the 
shape and size of the brain. Not so with the bones oi the 
They -rem to have a more independent development, 
which calls into action some different brain foi 

We notice that there seems to be an arrest oi development 
in tin- bones of the face at the time when the bulk develop- 
ment of the brain ceases. This normally Bhonld be at 

about the sixth or seventh year. 

The arrest oi development oi the bones begins to appear 
with the arrest oi bulk development of the brain, and only is 
complete when the brain is completely formed. 

It has been very properly observed that the human face 
is actually a result oi arrested development Frontal peculi- 
arities, common to man and other animal-, are retained at birth 
by the former, and the tlat face of the white man may be said 
to he an arrested foetal condition. The negro ha- the same 
fcatal appearance until puberty, when prognathism begins t" 
develop. 

The prognathism of the jaws of the negro is, I beb'eve, 
due entirely to the excessive development of the inferior 
maxilla. The rami and tin- body of the lower jaw, and also 
the muscles of mastication, are very large and massive as com- 
pared with those of the white man: while upon the other 
hand, the superior maxilla is small and more delicate. The 
constant force of the larger lower jaw upon the upper causes 
the alveolar process to l»e carried forward and upward, thus 
producing prognathism. The law of heredity, whereby the 
offspring tends to reproduce its kind, i- here nicely illus 
trated. This theory is easily demonstrated by the examina- 
tion of negro >kulls in the Army Medical Museum at Wash- 
ington and at the College of Surgeonsin London. The negro 
ni to. lay. especially those living in the Northern States, pos- 
sess jaws not unlike those of the white people: the zygomatic 
arches are smaller, the muscles Less dense and rigid, the 



52 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



lower jaw less massive, and orthognathism instead of prog- 
nathism exists to a certain extent. This is brought about by 
the arrest of development of the muscles and body of the 
lower jaw, due to change of climate, soil, and intermarrying 
of races. 

^ The principle is illustrated in plates 2 and 3 of my "Chart 
of the Typical Form of Constitutional Irregularities of the 
Teeth." 

The bones and teeth are formed largely from the phos- 
phates of calcium, sodium, etc.. which also afford material 




Fi S- 6 - Fig, 7.— From Serpa Pinto. 

for the brain growth. If the compounds circulating in the 
blood are consumed by an active brain, the teeth and bones 
will suffer in consequence, and ossification will take place 
slowly, the bones being found to be less massive at maturity, 
and, as is generally the case when there is great mental activity, 
there is less muscular activity, and the muscles are retarded 
in their development, being slight and requiring slight 
attachments; the ridges and protuberances on the bones are 
likewise but slightly developed, and we note their absence in 
the external expression. The vomer ossifies in different races 
at varying periods of life. In the white person it remains 
cartilaginous until comparatively late in life., about puberty, 



I II I III \l>. KACK, JAWS \M> I I I I II 






when the characteristic nasal formation is accomplished. Hut 
in the necro, and among some Mongolians, ossification of tin* 
septum takes place much earlier, and the oose being thus 
bound down to the maxilla the alas Bpread oul lidewayson 
the further facial growth, and the so-called tl.it nose results 
(see Figs. ,; and 1 These illustrations also BhoTi ex< ••- 
and arresl of development of the Lower jaw. 

Darwin notes that the 1 1 i ir 1 1 cheek hone- of the American 
Indian (Fig. v were due to the animal ancestral persistence 




Fig. 8. 

of extra development of the zygomatic arch. Clevenger,* 

mentions the larger size of the temporal muscle in ferocious 
animals, and the insertion of this muscle inside the zygoma, 
and claims that if the phylogenetic degeneration of the muscle 
from lower animals to savage and thence to civilized man is 
not kept pace with by the "cheek l>one>. " then prominence 
of the latter is produced. 

In the development of the bones of the head and inrv. 
climate, soil, and intermixture of races, and hereditary peculi- 
arities, enter into the formation of each distinct type of 

*The American Naturalist, July, 1888, in an article entitled " Cerebrology 
and Phrenology." 



54 ETIOLOGY OF OSSEOUS DEFORMITIES 

beings. Leave out any one of these and the type will soon 
become fixed. In a country like America, where the climate 
is so diversified, where different nationalities congregate and 
intermarriage is so common, deformities of the face and jaws 
must necessarily result, and many generations must have 
passed by before it is possible for a fixed type to be produced 
in this country like those of European countries. 

There is, however, another factor which must be consid- 
ered in connection with the development of the human race, 
that is not confined to America, but can be seen among all 
civilized nations, and one that has considerable weight in the 
development of the modern races — that is, Developmental 
Neuroses. This question is of more importance to us than 
any other, both from a social standpoint and also as regards 
the welfare of posterity. We shall see, in the chapter on 
Developmental Neuroses, that there is a tendency to produce 
atavism, or a return to the negro, Mongolian, or Indo- 
European types, and also that deformities of the nose, face, 
jaws and teeth result. 



CHAPTER VI. 

DEVELOPMENT I >F THE .1 AW - 

The author does not consider it necessary in this chapter 
to enter into the details of the embrj onic development oi the 
jaws for two reasons. First, he can add nothing to what has 
already been written upon this subject, and, second, he does 
not believe, from an experience of twenty years' Btudy, that 
the causes which produce constitutional deformities of the 
jaw ante. late the sixth year of the individual, except in the 
part which heredirj controls. 

It is a well known fact that those nation- or rare- which 
do not intermarry rarely, if ever, have irregularities or 
deformities. This illustrates well the advantage of marriage 

within thf same type. Irregularities of the teeth and jaw- 
are seldom found among pure Africans, Chinese, Italians and 
Jew-: but in those countries where all nation- of the world 
congregate and intermarry, irregularities of the jaw- and teeth 
must necessarily follow. 

A good illustration of this mixture of race- i- found among 
the people inhabiting the borders of different countries. Far 
rar -ay-: "The women of Albania, and tho&e of Biscay and 
Galicia, who. from religious scruples and national prejudice 
decline to intermarry with their neighbors, are much more 
beautiful than those of Piedmont or Fruili." 

In the Puritan- of New England the jaw- were in propor- 
tion to the remainder of the body, but after foreign nations 
began to pour into America and intermarriage to take place, 

very little of the Puritan stock remained, and the jaw- and 
teeth became degenerated in their development. 

The Largest normal jaw- are found among a few African 

race-, and the smallest among the Bushmen, Hottentot- and 
the people who inhabit the mountainous plateaus between 
Spain and Portugal. 

Mr. John R. Mummery, in a paper before the Odon tolog- 
ical Society of Great Britain, gives as the result of the exam 

.v. 



56 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

ination of 3,000 skulls of modern and ancient races, that the 
average width of the arch between the first molars in ancient 
races was about 2f inches, and modern uncivilized races 2-J- 
inches, while the greatest diameter was 2f inches. 

I cannot do better at this point than to quote from my work 
on " Degeneracy of the Jaws and Teeth of the Human Race": 

"Evolutionists and scientists have frequently mentioned 
the fact that the jaws are changing in shape and size, but they 
have never produced data to show just what changes have 
taken place. I have therefore collected a large number of 
measurements for the purpose of obtaining facts in regard to 
these changes. The measurements of the skulls of the early 
races, as well as modern people, were made from specimens 
in the museums and crypts of churches in Europe, where 
large collections of skulls have been placed. In many of the 
museums the skulls have been classified and tabulated in such 
a manner that an examination of them is easily made. The 
large Hunter collection of skulls at the College of Surgeons 
in London was examined by the late Mr. John Mummery; 
Dr. Betty, of Cincinnati, examined the large collection of 
skulls at the Smithsonian Institution in Washington; Dr. C. 
N. Peirce. of Philadelphia, crania in the Academy of Natural 
Sciences of that city ; Dr. Schuhmann. of Chicago, crania in 
Rome, Italy; Dr. Barrett, of Buffalo, crania in his private 
collection and in the Buffalo Academy of Natural Sciences: 
Dr. Pratt, crania in the Academy of Natural Sciences of 
Davenport, la. ; and I have made examinations of many skulls 
in different parts of Europe and also of the collection of Peru- 
vian skulls in the Michigan University at Ann Arbor and 
the Peabody Museum, Harvard College. 

"Measurements of the jaws of living individuals of differ- 
ent countries and nationalities have been taken by the fol- 
lowing dentists, as well as by myself: Dr. Caracatsanis. 
Athens, Greece; Drs. Franz Berggren and Elof Forberg. 
Stockholm, Sweden; Dr. A. Scheller, Warsaw. Poland; Dr. 
Johan Kier, Copenhagen, Denmark; Dr. Sturpenick, Brus- 
sels. Belgium; Dr. Ed. Wagner, North China; Drs. Perkins 
and Ivy, Shanghai, China: Dr. D. D. Bode, India; Dr. A.W. 
Baker, Dublin. Ireland; Drs. W. Barrett and Wm. Hern, 



I III III \l>. I \< I . ,IA\VH Wh I I I 1 II 



London, England; Dr. I N. Demorest, Santiago, Chile; Dr. 
Warren, Philadelphia, Pa.; Dr, B B Winder, Balti 
more, Md.; Dr. S I>. Hodge, Burlington, N't : Dr. w I. 
. Boston, Mass.; Dr. I '. Sill, Sen Xork, N 1 : Dra. 
Crisup, 1 1 m Cressiman, Volini and V D'Elia, Chicago, 
111. I wish at this point to thank those gentlemen \\ 1 1 « • bo 
kindly assisted me in the varj laborious work of obtaining 
these measurements, thus contributing their part to the pro 
M of science. The i >* •« »| » 1 1 • whose mouth- have been exam- 
ined comprise indn iduals in the different walk- of life, a part 
of them composing the patients of practitioners of dentistn 




and constituting the better classes, while other- arc dispens- 
ary patients and from the middle and poorer classes. 

*'The measurement was made across the upper jaw, from 
the outer surface of one firsj molar to tin- outer surface of 
the corresponding molar of the other side (Fig. 9). These 
points were taken because these molar- are the first teeth of 
the permanent set to develop, and from the fact that, devel- 
oping posterior to the temporary one-, they erupt independ- 
ently of and are not interfered with by any of the other teeth 
which arc in the jaw. The point of the jaw where these teeth 
are situated is the widest part that is normally developed and 
is not influenced by local causes; therefore this position was 
the most accessible for the object required. The measure- 
ments were made in the mouth- of persons over twenty-five 



58 



ETIOLOGY OF OS8EOU8 DEFOKMITIEg of 



years of age, irrespective of the exact age. for the reason that 
at this period, or nearly at this period, the individual has 
completed his growth. After this period the development of 
the skeleton is very slow, and at the age of thirtv to thirtv- 
nve ceases altogether. 

"In securing this large collection of measurements of crania 
and living individuals, the compilation of which has extended 
over a period of eight years. I have endeavored to show by 
actual demonstration that the jaw of the human race is dim- 
inishing in size. 

'The following is the table of measurements: 

EXAMINATION OF THE CKANIA 

Of Modern Races and Ancient Races m the Hunterian Museum by Dr. Mum- 
mery. Also crania in the Oxford University Museum, and 
in a number of private collections. 



MODERN RACES. 



LATERAL DIAMETER. 



No. 



MAXIMUM. 



In. Mr 



In. M. 



AVERAGE. 



In. Mm. 



Esquimaux (;() 

N. Americans (Coast) .' .' .' .' . '. \ ;,,'; 

X. Americans (Interior) 23 

S. Americans (Chile) 19 

Fiji Islanders 3^ 

Polynesians (Various). .'.'.'.'. 79 

Sandwich Islanders ' 21 

New Zealanders . ...... '. . (37 

Australians \\ 132 

TASMANIANS.. ' Q5 
-. r OO 

Malays 04 

Chinese ..,, 27 

East Indians (North)..'.'.'. " " ' 152 

East Indians (South) " 71 

Africans (East) 33 

CAFFRES 49 

Bosjesmen and Hottentots 29 

Africans (West) 23(3 

Ashantees 92 

Ancient Britons (Doiicho- V 

cephalic) f 68 

Ancient Britons (Brachy- ) 

cephalic) f 32 

Ancient Britons (Canon / 

Greenwell's Explorations) \ 59 
Ancient Britons iMiscel- ) 

laneous). C 44 

Romano-Britons ...... 143 

Anglo-Saxons [ ;,-, 

A ncibnt Egyptians ! ' .' ...' 3,; 



2.375 

2.375 
2.375 
2 500 

2.500 

•J. 375 

2.500 

2.375 

2.250 
2.250 
2.125 
2.125 

2.125 
3.250 

2.500 

•:.}■::, 
2.125 
2.125 

2.125 

2.125 
2.250 
2.125 



60.32 
50.32 
60.32 

03.50 
63.50 
60.32 
60.32 
63.50 
60.32 
60.32 
60.32 
57.14 
57.14 
53.97 
53.97 
60.32 
53.(17 
57.14 

53.97 



2.750 

2 750 
2.625 
2.750 
2.875 
2.625 
2.625 

2.750 
2.625 

^.750 
2.625 

2.750 
2.500 

•j.::... 
2.875 
•2.375 
2.750 

•.'.-75 

2.625 

•J. 50(1 
2.500 
2.500 



53.H7 2.625 
57.14 2.625 
53.97 2.625 66.68 



69.85 
66.68 
69.85 
73.02 
66.68 
66.68 
73.02 
69.85 
66.68 
69.85 
66.68 
69.85 
63.50 
69.85 

60.32 
69.85 

73.02 

66.68 
63.50 
63.50 

63.50 

66.68 
66.68 



2.562 
2.562 

2.500 
2.(525 
2.687 

•J. 5l HI 

2.500 
2.687 
2.562 
2.500 
2.562 
2.437 
2.500 
2.312 
•J. 43 7 
2.625 
2.250 
2.500 
2.687 

2.375 
2.31^ 
2.312 

2.312 

■J.:;7.5 
2.437 
2.375 



65.07 
65.07 
63.50 
66.67 
68.26 
63.50 
63 . 50 
68.26 
65.07 

6J 91 
63.49 

58.73 
61 .91 

57 14 
63 . 50 
68.26 

60.32 

3 
58.73 

: - i 

60.32 

61.91 

<;«'.::•.' 



I Ml HKAD, 1 v E, JAWS \\i- l I I l II 









EXAMINATION 01 



« I : \ \ I \ 
Acadetii) 






1'hTladetpm inny Mumuii'i; 

En»ili«h Crania in European museum*, and private colleetiun 

. |», .,, , . ^chuhmann, Barrett, Pratt, 

ami Talbot. 









l. \i KB *L imamki ER. 




K.\< 


MINIMI M. 


MWIMI M. 








III. 


Mm. 


111. 


Mm 


In. 


Mm. 


Europeans \ 

. mans, Italians, 




1.94 


L9.19 


- 




M 












' 


1 


1.88 




2 H 


61.90 




- 


Sandwich Isi inders . . . 

1 - 


M 


2.13 










- 


1 




























2 * 


M 


2.00 


- 










1 


L.88 






- 






(in 


2.00 






- 




58.45 


An< ii n r CAl [PORN 














from 5 u»ds, 1 ,4 


M 










2.31 


- - 


tlifornia; Santa 


! 






2.44 


61.90 




57.14 


Catalina Island, Brazil; | ' 
















\ • Miguel. . 1 
















Mi SICANS 


? 


1.94 


19.19 


2.50 




2.31 


58.84 


. 


M 










2.31 




(. \1 [PORNIAN iNDl *NS. . . 


1 


2 06 












Builders, Mound- 1 

in Kentucky and Tonnes- - 


M 














V 


2.00 


50.80 






- 




see. ' 


57 


? 
































Cumberland Valley, Ten- | 


8*3 


M 








- 




61.90 


nessee:Illinois River. Indi- ■[ 


- 


F 


L.88 












ana: Arkansas. Michigan j 


11 


? 


2.13 




2.44 


61.90 


- 




and various places 

INDIANS North American. \ 


















17 


M 






2.50 






5 


1 1 


1 


2.13 




2.31 








Different Tribes J 


i'.n 


: j 


L.88 








2.31 




Negro — Rio de Favino 


1 




2.19 




2.19 




2.19 




Fl \ l H K LDS from 1 >r 

Washington, Gulf of-, 
Georgia, Peru ' 




M 




57.13 


2.50 






62.31 


•> 


F 








61.90 


- 




18 


? 








8 






Crania from San Lorenzo j 


4 


M 












3 


Cave. Mexico 1 


3 


1 


2.13 








2.20 




Crania from Caves in Ten \ 


} 


M 






2.19 




2.1 * 




















nessee. Kentucky, Mexico- j 


1 








57.13 


2.19 




ESQUIMAUX from Labrador, i, 


10 


? 


L.75 


L4.46 










Norton Sound / 


• ' 


M 




57.13 






- :,7.'.'-: 


Hindoos 


1 


M 


2.13 








2.13 


1 


? 














1 




1 














Herney Islanders 


3 


M 


2.19 










59.13 


1 


? 










2.13 




Hawaiian Islander 


1 


M 






S8.84 







60 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



EXAMINATION OF CRANIA— CONTINUED. 



RACE. 



Negroes, African Negroes. 

Zulus, South Africa J 

Probably Africans 

Negro Giles, executed at V 

Richmond, Va f 

Aleutian Islander ....... 

Guanche 

Pegu, Burmah ...... 

Mauritian Dwarf. ....... 

Unknown j 



No. 



Sex 



Fiji Islanders 

Loo Choo Islander . 

Burmese [ 

Marquesas Islanders!.' 

Assiniboin 

Kankakee \' m 

Malay ! ! ! ! ! 

Tahitian ......! 

Tatlit Koochin [[ 

Laplanders [ 

Japanese " " < 

Parsee 

Australians. . . . ' .' ] ' ' \ 

Armenians \\\ 

Samoan Islander 

Ancient Egyptian (Egyp- 
tian Type) 

Ancient Egyptian ' (Neg- 
roid Type) 

Copt 

Egyptian Negroes.' .... [ 

Ancient Egyptians '. 

Arab 

Choctaw and Negro] '. '. '. 

Hispano-Peruvian 

Dutch 

Anglo-American.. ..... 

Recent Crania, Pa. '('?).' .' , 



Total. 



1 
1 

1 

1 
3 
5 
2 

1 
1 
4 
3 
5 
13 
2 
2 
2 

1 
2 

10 

4 

1 

18 

11 

1 
3 

27 
2 

1 
2 

1 

1 

• »•) 



1840 



M 

? 

F 

F 
M 
F 

M 

F 
F 
F 

? 

M 
F 

? 
? 
? 

? 
? 
? 
? 
? 
? 
? 
? 
? 

? 
? 
? 



LATERAL DIAMETER. 



minimum. 



In. Mm. 



2 . 1 3 
1.88 
2.25 

2.44 
2.00 

2.31 

2.13 

2.06 

2.19 

2.19 

2.31 

1.88 

2.31 

2.37 

2.47 

2.28 

2.28 

2. Hi 

2.1(> 

2.25 

2.22 

2.37 

2.37 

1.97 

2.09 

2.00 

2.25 



maximum. 



In. Mm. 



53 '.C> 
47.(52 
57.13 
57.13 
61.90 
50.80 

58.84 

53.95 
52.32 

:».").;, i i 

55.56 

58.84 

47.62 

58.84 

60.30 

62.70 

57.92 

57.92 

54.75 

54.75 

57.13 

56.35 

60.30 

60.30 

50.07 

53.13 

50.80 

57.13 



1.88 
1.88 
2.1!) 
2.19 
2.13 
2.5.1 
2.50 
1.97 



47.(12 

53.95 

53.D5 
47. 62 
47.(52 
55.56 
55.56 
53.95 
65.08 
(i;!.^d 

50.07 



2.50 
2.47 
2.25 
2.25 

2 44 
2.25 

2.31 

2.13 
2.06 
2.19 

2.19 
2.44 

2.31 
2.44 
2.37 
2.47 
2.44 
2.37 
2.31 
2.53 
2.47 
2.34 
2.50 
2.37 
2.00 
2.69 
2.09 
2.25 



2.50 

2.69 

2.13 
2.13 
2.22 
2.31 

2.19 

-> .>., 

2.5(1 
2.50 
2.50 



6! 3.50 
62 7o 
57.13 
57.13 
61.90 
57.13 

58.84 

53.95 

52.:', 2 

:>:> 5c, 

55.56 

61.90 

58.84 

61.90 

60.30 

(12.70 

61.90 

60.30 

58.84 

64.29 

62.70 

59.57 

63.50 

60.30 

50.80 

68.26 

53.13 

57.13 

63.50 



average. 



In. Mm. 



2.31 

2. 25 
2.25 

2 4 + 
2.13 

2.31 

2.13 

2. 

9. 



68.26 

53.95 
53.95 

5(1.35 
58.84 
55.5(1 
5(1.35 
65.08 
63.50 
63.50 



06 

19 
2.19 
2.37 
2.13 
2.37 
2.37 
2.47 
2.36 
2.31 
2.25 
2.37 
2.36 
2.28 
2.44 
2.37 
1.98 
2.31 
2.06 
2.25 



., •> 



1-88 47.62_ J3 1 69 68.26 2.28 57.94 



2.37 

2.13 
2.01 
2.06 

2.25 
2.19 
2.17 
2.50 
2.50 
2.30 



58.84 
57. 5 s 
57.13 
57.13 
61.90 
53.95 

58.84 

53.95 

52.32 

55.5(1 

55.56 

60.30 

53.95 

60.30 

60.30 

62.70 

59.91 

58.84 

57.14 

60.30 

59.91 

57.92 

61.90 

60.30 

50.40 

58.84 

52.29 

57.13 

55.95 

60.30 

53.95 

51.05 
52.5!) 
57.14 
55.5(1 
55.1(1 
65.08 
63.50 
58.45 



I 111 III Vl». I V< I . I \W - \ N I » 111111 



•■I 



EXAMINATION Ol 1 in MOU1 H. 
Of Liring Parsons, Showing M< or MaiUla. 



LA I I i; W. DIAMKTKH. 



RA< I.. 



\ ! hi' n -. 


• it'll 

ahagen, Denmark. . 

.in , 
. Poland . 

China 

Typical People of India 

Italians 

Santiago, Chile 
London. England 
Dublin, Ireland . . 



American-born Negroes. . 

Dispensary patient: 

Philadelphia, Baltimore 
and Boston 

K s dents of Burlington, 
monl 

Boston. Mass 



New York City 

Chicago and Illinois 
Marshpee Indians. 

Total 




51.19 



62 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



EXAMINATION OF THE CRANIA. 

In Peabody Museum. Harvard University: Academy of Natural Sciences, 
Philadelphia; Davenport Academy. Army Museum: Roman. French, and 
English Crania in European museums, and private collection of Barrett 
Miscellaneous crania by Drs. Peirce. Newton. Schuhmann. Barrett. Pratt. 
Jt5etty. and lalbot. 



RACE. 



No. 



Ei'ROPEANS — Ancient and f 
Modern Romans, Lake j 
Dwellers, French prior to J 

nineteenth century { 

I 



Sandwich Islander: 



Ancient Peruvians. 



Ancient Californians. 



Californian Indians.. 



Mound Builders. 



Stone Grave People- 
Cumberland Valley. . . , 



Indians. 



Negro — Rio de Favino 

Flat Heads from Oregon, ( 
Washington, Gulf of - 
Georgio, Peru ( 

Crania from San Lorenzo j 
Cave, Mexico ^ 

Crania from Caves in i 
Tennessee, Kentucky,-] 
Mexico ( 

Esquimaux from Labrador, j 
Norton Sound ) 



Hindoos. 



Herney Islanders 

Hawaiian Islander 

Negroes, African Negroes. 






26 
29 

122 

104 

2 

26 

32 

130 

\ 32 

) 30 



83 

1 

83 

80 

110 

58 
3 

1 
3 

• > 

1 
4 
3 
4 



Sex 



M 

F 

M 

F 
M 
F 

? 

M 
F 

? 

M 

F 

M 
F 
? 

M 

F 
? 

M 
F 
? 
? 

M 
F 
? 

M 
F 
M 

? 



ANTERO-POSTERIOR DIAMETER. 



MINIMUM. MAXIMUM. AVERAGE. 



In. ; Mm. 



1.69 
L.56 

1.63 
1.63 
1.56 
L.56 

1.69 
1.63 
1.69 



1.69 
1.69 
1.56 
1.63 
2.00 
1.63 
1.63 
1.88 
1.75 
1.38 
1.81 
2.06 
1.88 
1.88 
2.00 
1.69 
1.75 
1.69 



42.86 
39.69 

41.28 

41.28 
39.69 
39.69 
42.86 
41.28 
42.86 



In. Mm. 



In. 



42.86 
42.86 
39.69 
41.28 
50.80 
41.28 
41.28 
47.62 
44.46 
35.09 
4(1.04 
52.32 
47.62 
47.62 
50.80 
42.86 
44.46 
42.86 



2.00 
2.06 

2.19 

2.03 
2.13 
2.13 
1.94 
2.13 
2.06 



1.75 44.46 



L.69 

1.69 



1.81 



2.00 
2.06 



42.86 
42.86 



4.',. 1 14 
47.r,-j 



52.32 



2.13 
2.00 
2.31 
2.13 
2.00 
2.2:, 
2.06 
2.00 
2.31 
2.31 
2.00 
2.06 
2.25 
2.00 
2.00 
2.00 
1.94 
1.88 



50.80 
52.32 

55.56 
51.56 

53. '.>;, 
5 3.9 5 
49.14 
53.95 
52.32 



53.95 

50.80 
58.69 

53.95 
50.80 
57.03 
52.32 

50.80 
58.69 
58.69 
50.80 
52.32 
57.13 
50.80 
50.80 
50. 80 
49.14 
47.62 



2.00 50.80 



2.13 

2.00 



1.81 
2.00 



2.00 
2.13 



1.86 
1.83 

1.91 
1.83 
1.88 
1.79 
1.84 
1.89 
1.86 
1.83 
1.91 
1.83 
2.00 
1.89 
2.00 
1.97 
1.91 
1 94 
1.99 
1 87 
1.91 
206 
2.00 
1.94 
2.00 
1.83 
1.83 
1.79 



1.83 



53.95 1.72 
50.80 1.69 



4«;.()4 
50.80 



1.81 
1.92 



50.80 2.00 50.80 
53.95 2.09 53.18 



Mm. 



47.23 
46.43 

48.38 
46.43 
47.62 
45.64 
46.83 
48.02 
47.23 
46.40 
48 38 
46.43 
50.80 
48 02 
50.80 
50.00 
48.41 
49.21 
50.55 
47.44 
48.38 
52.32 
50.80 
49.21 
50.80 
46.43 
46.43 
45.64 



46.43 



43.65 

42. 86 



46.04 
48.81 



mm ii r \i>. »• \< i . i \\\ - w i. i i i i n 



• 



I \ \MIS \ I I..N ill I III ORANIi ■ I 'N I l\l I I. 

In Peabodj Museum, Harvard I i Uwdemj of Natural 

l'»ul:». 

English Crania in European museums, and private collection of I 

Miscellaneous crania bj Dr> I ton. Schuhmam 









- 


an I ERO P081 ERIOB DIAMJ 


KA' 
















M1MM1 M. 


MWIMI M. 






hi. 


Mm. 


In. 


Mm. 


In. 


Mil. 


/ui us, South Africa . . 




i 


1 


L.94 


19.1 1 


L.94 


L9.14 


L.94 


19.1 » 




i 


^1 




S 




9 




- 


\l kh \\~. . 






1 














cecuted 














Richmond, Va 


i 


M 


2.19 




2.19 




2.19 




[SL tNDER. . . 




i 


l 


2.13 












ill 




i 


F 


1.63 


H.28 


L.63 


H.28 


1 63 




Burxnab 




i 


1 


38 


17.62 


38 




L.88 




Mauri n \s Dwarf. . . . 




i 




2.13 




2. l.'. 






- 


AN. . . 


1 




M 


1.8] 


16.04 






L.95 


49.60 




i 


.) 


1 


1.69 






8 


L.91 


18. H 


Fiji [si aNDEks 


1 


i 


M 


- 




2.28 




- 






' 


i 


1- 


53.19 








53 L9 


Bavari \n . ... 


: 


i 


M 


2.13 




2.13 




2.13 






i 


* 


L.81 


16.04 


L.81 


L6.04 


L.81 




Zl U aNDRRS . 






M 


L.66 




2.13 




L.92 






' 




h 


1 . 75 


14.46 




51.56 


1.93 


49.00 


AUSTRIANS 






M 


1.94 




2.01 


51.05 


L.96 


- 






1- 


1.75 


14.46 


2.13 




L.94 




Chinese 




i 


M 




53.19 




53.19 




53.19 




i 


1- 


L.94 




L.94 




L.94 




JAPANESE. 


: 


i 


M 


L.91 




1.91 




L.91 






i 


P 














A STRAUANS 




i 


M 


2.25 


57.13 




57.13 


2.25 






2 


P 


1.75 


44.46 


- 




2.01 


51.05 


SAMOAM \<\ UfDBR .... 




1 


M 


1 94 


r< 25 


L.94 19.25 
2 00 


L.94 


- 


■R< -MAN 




1 


M 


2.00 


- 




1 


h 


17.62 






L.88 




R< iii ^no-British. . 




j 


F 


l B4 i > '• ~ i 


L.84 


16.74 


L.84 
L.98 


16.74 


Whites 




3 


M 


L. 75 


(4 16 




1 


1- 


2.19 




•M'.< 




2.19 




Egyptian 




1 


F 


L.81 


51.56 


L.81 
2.19 


L6.04 


L.81 


(6.04 


American N 






M 






1- 






2.13 




S 




Marshpee Indi uis. .... 




34 




1.75 


14. 16 






L.98 




P.itients a n d Friends 




















Author 


. L2 




L.56 




2.19 




1 -1 


L6.74 


Total 


JO 15 





1.66 




2.04 




51.42 





64 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



EXAMINATION OF THE CRANIA— CONTINUED. 

In Peabody Museum, Harvard University; Academy of Natural Sciences 
Philadelphia; Davenport Academy, Army Museum; Roman, French, and 
English Crania in European museums, and private collection of Barrett. 
Miscellaneous crania by Drs. Peirce, Newton. Schuhmann, Barrett, Pratt! 
Betty, and Talbot. 



RACE. 



Europeans — Ancient and ~\ 
Modern Romans; Lake ! 
Dwellers; French prior to [ 
nineteenth century J 

Sandwich Islanders 



■- 



Ancient Peruvians. 



Ancient Californians. . . 
Californian Indians -j 

Mound Builders 

Stone Grave People — ( 
Cumberland Valley *j 

Indians 

Negro — Rio de Favino . 

Flat Heads from Oregon, i 
Washington, Gulf of -j 
Georgia, Peru ( 

Crania from San Lorenzo \ 
Cave, Mexico "j 

Crania from Caves in 
Tennessee, Kentucky, 
Mexico 

Esquimaux from Labrador, \ 
Norton Sound ) 

Hindoos ) 

Herney Islanders - 

Hawaiian Islander 

Negroes, African Negroes. 
Zulus, South Africa - 



No. 


Sex 


HEIGHT OF VAULT. 








34 


M 


MINIMUM. 


MAXIMUM. 


AVERAGE. 


In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


.25 


6.35 


.69 


17.52 


.53 


13.46 


30 


b 


.31 


7.65 


.63 


16.00 


.48 


12.19 


25 


M 


.37 


9.39 


.75 


19.05 


.55 


13.97 


26 


b 


.31 


7.62 


.69 


L7.52 


.5:.' 


13.21 


137 


M 


.25 


.•...•i:, 


.81 


•.'0.57 


.57 


14.47 


124 


b 


.37 


9.39 


.75 


19.05 


.57 


14.47 


17 


? 


• 44 


11.17 


.63 


16.00 


.49 


12.45 


34 


M 


.44 


11.17 


.69 


17.52 


.55 


13.97 


38 


b 


.44 


11.17 


.75 


19.05 


.55 


13.97 


29 


M 


.41 


10.45 


.69 


17..V.* 


.54 


13.71 


26 


F 


.44 


11.17 


.69 


17.52 


.52 


13.21 


56 


M 


.44 


11.17 


.72 


18.29 


. 5 5 


13.97 


47 


Jb 


.44 


11.17 


.69 


17.52 


.5.) 


14.23 


: 


? 


.41 


10.45 


.66 


16.78 


.51 


12.95 


87 


M 


.41 


10. 4:» 


.88 


22.35 


.60 


15.02 


89 


b 


.37 


9.3'.) 


.75 


19.05 


.55 


13.97 


11 


? 


.37 


9.39 


.56 


14.23 


.50 


12.70 


17 


M 


.44 


11.17 


.69 


L7.52 


.57 


14.47 


11 


b 


.41 


10.45 


.59 


14.98 


.47 


11.93 


3 


? 


.50 


L2.70 


.63 


16.00 


.5.; 


14.23 


1 












.50 


12.70 


3 


ivi 


.50 


12.70 


.75 


19.05 


.65 


16.51 


2 


F 


.50 


12.70 


.56 


14.23 


.53 


13.46 


1 


? 


.50 


12.70 


.50 


L2.70 


.50 


12.70 


4 


M 


.50 


12.70 


.69 


L7.52 


.60 


15.02 


3 


F 


.44 


11.17 


.66 


16.78 


.54 


13.71 


3 


M 

? 


.53 


13.46 


.53 


13.46 


.53 


13.46 


3 


F 

> 


.47 


11.93 


.53 


13.46 


.51 


12.95 


2 


M 


.50 


12.70 


.56 


14.23 


.53 


13.46 


1 
3 


M 

? 

F 


.;>() 


12.70 


.50 


12.70 


.50 


12.70 


.44 


11.17 


.69 


17. 5 -J 


.60 


15.02 


3 


M 

? 


.44 


11.17 


.63 


16.00 


.57 


14.47 


1 


M 


.63 


16.00 


.63 


16.00 


.63 


16.00 


2 


M 

? 


.53 


13.46 


.63 


16.00 


.57 


14.47 


1 


F 


.44 


11.17 


.44 


11.17 


.44 


11.17 


1 


F 


.50 


12.70 


.50 


12.70 


.50 


12.70 


1 


M 


.75 


19.05 


.75 ! 


19.05 


.75 


19.05 



I III III \l>. PACK, lAWa \M> 1 I I I II 






EXAMINATION Ol I 111 (KAMA 



N I I\l I I 



In PMlbod) MOMUm, H.irxai.l t in \ 81*11 \ ; \.-;i.l. m\ 

Philadelphia; Davenport Academy, Ann j Muneuni; Roman, French, and 
Kngliflh Crania in European museums, and Private collection ol i 
Mirtccllancoua crauia bj Dm. t'eirce, Newton, Schuhmai Pratt, 

Bettj . and 1 albot 





\... 




HEIGHT mi vai l.l. 


i; \« 1 


MIMMl If. 


MWIMl M. 






In. 


Mm. 


In. 


Mm. 


In. 




\ 
Giles, executed at 1 

Richmon 1, Va \ 

\ ian Islander 

<- \N' HI 

l'i n . Bttimah . 


■ > 

1 

1 
1 
1 
1 

3 
5 
16 


1- 
M 

F 

l 

F 

? 

M 

F 


.11 

.31 

. II 
.50 

.41 


11.17 
12 70 

11.17 
12.70 
12.70 
13. 16 
L3.46 
10. 15 


. :.. i 

.31 
.44 
.50 


12.70 

12.70 
12.70 
I 1.23 

16.00 


.31 
.44 

.;,u 
.50 
.54 

. 5 .' 


i L.9 ; 

11.17 


Mauri pian i >\\ arf 

IWN -J 

M IRSHP1 1 [NDIANS 


13.71 

1 l. 17 
13.22 






Total 


954 




. II 


1 1.36 


.62 


15. 18 


,., 





The averages in table on page ."- s are made up from the 
maximum and minimum figures alone while those in the 
other tables are deduced from the total of all the measure 

ment-. 

" While one would naturally expect to find discrepancies In 
the figures in a work like this, in which so many differenl 
individuals have been engaged, great care was exercised in 
selecting gentlemen (most of whom art' personal friends of 
mine and well known in the profession) who possessed ^kill 
and who had also attained prominence in their calling. 

-• In comparing the measurements of Living individuals 
with those of the crania, an allowance oi ' ,,; of an inch should 
be math' for thickness of the mucous membrane. 

"The difference in the number of measurements of the 
anteroposterior and the lateral diameter is due to the fact 
that in many cases the anteroposterior diameter was taken 
from the tirst and second molars instead of from the third: 
it was necessary to reject all such measurements. 

•• We must therefore look upon these figures as being nearly 



«'>♦', ETIOLOGY OF OSSEOUS DEFORMITIES OF 

correct in each individual case, because the work is positive 
in its nature, and the figures are simply a matter of record as 
presented by the instrument. 

MOUTHS OF LIVING PERSONS LATERAL DIAMETER. 

"A careful study of the table will show that the diameter 
of the jaws depends to a great extent upon the size of the 
skeleton; thus a small person will possess a small jaw. a 
large person a large jaw. This, however, is not invariable. 
We frequently find small people with large jaws, like the 
cretins of Switzerland, and large people with small jaws, as 
is frequently observed in limestone countries. This condi- 
tion is also frequently due to excessive or arrested develop- 
ment of the maxillae. We notice that there is as marked a 
difference between the size of the jaws of the male and female 
as there is in the size of the skeleton of the two sexes. This 
difference ranges from .02 to .16 of an inch, and is charac- 
teristic not only of living individuals, but it was also observed 
in the measurements of the crania of the ancient races. 

"We also note that the lateral diameter of the jaws of liv- 
ing persons in the old country is greater, with the exception 
of the Athenians, than it is in this country at the present 
time, and the jaws of the native Indian races of this country 
are much larger than the jaws of the white people at the 
present time. The jaws of the people in older parts of this 
country are smaller than the jaws of people in the newer 
parts, as illustrated in the measurements of the jaws of the 
residents of Boston and those of Chicago. 

"There is also a marked difference between the diameters 
of the jaws of dispensary patients and poorer patients, and 
those observed in private practice among the wealthier 
classes. This is well illustrated in the measurements of 
patients by Dr. Cressiman and those measured by the author. 

"This is also well illustrated in measurements by the 
author of patients in the office of Dr. Shepard, of Boston, 
and those made by Dr. W. E. Page, of Boston; Dr. Winder, 
of Baltimore, and Dr. Warren, of Philadelphia, who made 
examinations of dispensary patients. A very interesting 



I ill ill \l>. I \< i . JAWfl \s Ill 

point to be Dotioed is thai the purer and more olannish the 
race, the smaller the range io the figures representing the 
diameters of tin- jaw b. 

u Thus we see in the measurements of tin- jaws of the 
Chinese the range is only from 2 t<» •_'. 11. with <m<' measure- 
ment .-it 2.52; the people of India, 1.94 to 2.37; the negro, 
8.071 the Marshpee Indians, 2 to 2.50; while in them 

race- the range is from L.50 t * > 2.75, extending over a much 
greater latitude than In the pure races. Thus In the Sw< 
we notice thai the range Is from i. vv to 2.63; In Dublin from 
l. s ^ to 2.50; in London from L. 88 to 2.44; while the range 
i>\' the white people in America i- from L.50 to 2.63. This 
disparity in the size show- that in mixed races and those of a 
nervous temperament the arrest of development and exces 
sive development of the jaws arc very common; while on the 
other hand, in those races whose customs have been the same 
for hundreds of years, where the soil, climate, and environ- 
ments have been unchanged, who have intermarried among 
themselves, very little difference in the size of the jaws is 
noticed. There is also a difference noticed in people who live 
at different heights of the same country, as in Northern and 
Southern Italy, and in different part- of America. 

•• It is not necessary to take measurement- of different 
nationalities to -how that the jaws are diminishing in size. 
but simply compare the measurements <>i the jaws of the 
same nationality at different periods of its history. Thus the 
early Britons possessed jaws which measured from 2.12 to 
2.62 in their lateral diameters, while the jaws of the present 
English people measure from l. sv to 2.44 inches. It will be 
noticed that the minimum diameter has decreased more than 
the maximum. Again, by comparing the ancient Romans 
with the modern Italian- of Southern Italy, we find that the 
jaws of the early Romans measured from 'J. 12 to 2.62, while 
the jaws of the present Southern Italian- measure only 1.94 
to 2.69. 

11 In comparing the measurements oi the uncivilized races 
with those of the civilized, it will be observed that the jaws 
of the former are much larger than those of the latter. In 



68 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the majority of cases the size and shape of the jaw are com- 
mensurate with the osseous structure of the individual. The 
Bosjesmen and Hottentots present the smallest range in the 
size of the jaw, 2.12 to 2.37 inches. As is well known, they 
are the most inferior of races (with the exception of the 
Australians), mentally and physically. They are nomadic in 
habit, and are often driven from place to place by stronger 
tribes. Their food often consists for some time of herbs, 
roots, berries, plantain, etc. The meat consists chiefly of 
rats, dogs, etc., and they are obliged sometimes to feed upon 
locusts, ants, lizards, and frogs. This mode of life is as 
artificial in one direction as is the life of the present highly 
civilized races in the opposite direction. The people dwell 
along the banks of rivers, near marshes, where hygienic sur- 
roundings are wanting. 

44 The Chinese live under artificial conditions also, and the 
size of their jaws range from 2.25 to 2.62 inches. Of the 
East Indians, those living in the north are of tall stature and 
well developed. They live on the high plateaus, while those 
in the south live in valleys. The physical development of 
the latter is less, and their maxillae are smaller than the 
former. 

"The Esquimaux are of short stature, but of remarkably 
well-developed physique. Their maxillae are large in pro- 
portion to the osseous development. 

"The Australians are the lowest types of mankind, and 
their jaws range from 2.37 to 2.75 inches. The jaws are very 
large in proportion to the size of the cranium. The Fiji 
Islanders and the New Zealanders are among the best devel- 
oped, physically, of any of the races, past or present. Their 
jaws are large, ranging from 2.50 to 2.75 inches. Very few 
cases of caries were found by Dr. Mummery. The Poly- 
nesians and Sandwich Islanders are slightly inferior to the 
former, and we find this inferiority marked in the jaws also. 

" The South Americans from Chile, occupying the western 
side of the Andes, are descended from Spanish and Indian 
ancestors. Their teeth are very large. The North Ameri- 
can Indians present very large jaws. They are well devel- 



i ill HEAD, i \' i . JAWfi wi- i i i i ii 

oped physical h also, Among the ancient Britons we would 
expect i" tin! that the dolichocephalic maxillae were nar 
rower in proportion i«» the length, and the brachycephalic 
maxillae broader. The length of the maxilla? has not been 
given, consequently the relative proportion of length and 
breadth cannot be determined, but we notice that the maxi 
mi nn brachycephalic ja* la 2.50 inches, while that of the 
dolichocephalic is 2. 75 inches. The brachycephalic Britons 
were more civilized than the former, and lived under more 
artificial conditions, which fact will help sustain the theory 
advanced by me thai the higher civilization is attended with 
lessened de> elopment of the maxilla-. 

u Comparing the ancient race- with the modern races, we 
find the rani!*' of the former is 2.12 to 2.62 inches, while that 
of the modern is 2.12 to _. v 7 inches. Only three of the 
modern race-, however, have a minimum of 2.12, while the 

minimum of all the ancient race-, with the exception of the 
Anglo Saxon-, i- 2.12 inches. The maximum of the ancient 
race- i- Less than that of the former. This fact, that the jaw- 
of these people are smaller than those of the modern races, 
i- another proof of the truth of the theory that civilization is 
accompanied by decrease in the size of the jaw: for these 
ancient race- were possessed of a higher civilization than the 
modern races, who, with few exceptions, are in a state of 
barbarism. 

\\ I l.ia • -!•« >8TERI< >B DIAMETER. 

u The anteroposterior diameter was taken from the alveolar 
process at a point between the central incisors extending hack- 
ward in the median line and meetings line drawn at right 
angles to the posterior surface of the third molar, as illus- 
trated in Fig. 1". 

" It is a singular fact that the same law- hold good for the 
development of the anteroposterior diameter that were laid 
down for the lateral diameter. Although these examinations 
were made by different persons, in different parts of the coun- 
try, we find that the antero-posterior diameter of the jaw of 
the female is less than that of the male l>v from .02 to .24 of 



TO 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



an inch. This disparity, as compared with that of the lateral 
diameters, is a natural one. After the temporary teeth are 
all in place, the natural development of the jaw is in an 
antero-posterior direction, and the natural changes that are 
taking place in the evolution of the face and jaws consist of a 
shortening of the antero-posterior diameter. The great range 
of difference is due to the fact that it is quite common to find 
in some individuals an entire arrest of development of the 
posterior part of the body of the jaw. This is always the 
case when permanent molars have been extracted, thus allow- 
ing the third molar to come forward, or when the individual 




Fig. 10. 

has inherited the large jaw of one parent and the small teeth 
of the other parent, or when the jaws have become arrested 
in development from constitutional disease. In comparing 
the antero-posterior diameter of the jaws of people of one 
nation with those of another nation, we must take into con- 
sideration the character of the skull. In the brachycephalic 
type of the Chinese we find the broad jaw, and in the doli- 
chocephalic type of the negro, the long jaw. This difference, 
however, is only applicable to the pure races, and can be 
noticed only by comparing the external condition of the head 
or skull with the jaw. If we were to examine two or three 
thousand plaster casts of the mouths of a mixed class of peo- 



i in 111 u>, PACE, I \w - \m» 1 1 i i ii 71 

pie, we would be unable to say that this one belong 
bracbyoephalio individual and that one belonged to a doli 

ehooephalio Individual. The local conditions so i \if\ the 

Bhape of the jaw thai in the mixed classes there ifl not thai 
correlation between the Bhape of the -k « 1 1 1 and jaw whicb we 
6nd in the pure races. The fact that tin- jaw develo] 
lengthens from before backward would naturally impress one 
with the fact that if the jaws were not exercised b\ mastica- 
tion, or it an\ of the permanent teeth bad been extracted, or 
if a third molar tailed t<> make its appearance, the length 
required would necessarily be much less than that required 
by a jaw full of teeth and one that had been well exercised. 
Therefore nature developed only the posterior part of the 
jaw, that whioh is actually necessary, and hence the short 
lower jaw. 

HEIGHT OF VAULT. 

••The height of the vault in most cases is far below the 
average of the present day. In t,61 I measurements of nor- 
mal individuals, made by the author, it was found that the 
average height of the arch was .58 of an inch: the measure- 
ment was made from the alveolar border between the second 

bicuspid and the first permanent molar to the height of the 

arch. Fig. 11 illustrates an instrument invented by me for 
the purpose of measuring these cases; it also -how- the posi- 
tion of the instrument upon the model when the measure- 
ment is ma. Ic 

•• It was necessary to group both male and female, because 
some <>t the measurements were taken from plaster casts, bo 
that I was unable to determine the sex. 

"In comparing the width of the jaw- of people whose 
ancestors have lived in tin- country for many years, it will 
be -ecu that there i- not -uch a great difference in the width 
of the jaw-. Thus, private female patients in Burlington, 
Yt.. Boston and Chicago, -how that there i- only about 
mm., while in male patient- only about 1 mm. 

•• By comparing these measurements with the ancient Eng- 
lish, a- made by Mr. Mummery and Mr. Coleman, we find a 



72 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 




Fig. 11. 



I II I III. M». I \» I . I \\\ - \M> I I I I II 

difference of about 12 mm., and tin- difference be! 
ancient Romans about tin- same, The difference between 
the ancient English and the English of todaj is about - mm., 
and the ancient U « > n 1 .- 1 n - and present Italian* ol Southern 

Italy 1"..'." mm. 

"The antero posterior diameter of the present size oi the 
jaws is about as lov« as the lowest of an\ ol the measure 
ments, 

•- 1»\ comparing my measurements «>t" New England stock 
with the ancient Britons, a- made by Mr. Mummery and Mr. 
Coleman, I find a difference from 7.79 t<> 12 mm.; between 
ancient Roman- and N»'\\ EIngland stock L0.97 mm.: between 
the Anglo-Saxons and Ne* England stock 9*38 mm.: and 
between New England stock and present English 3.02 mm. 

"There would be a much greater difference shown in the 
width of tin- jaw of New England stock of today, and that of 
the skulls of earl\ races, if the measurements had been taken 
from the first or second bicuspid region, because the greatest 
contraction is anterior to the first permanent molar. 

" I have frequently made the statement thai the teeth are 
the same size today that they were three thousand years ago. 
These measurements bear me out in that statement. While 
the lateral diameter of the jaws is considerably smaller, the 
anteroposterior diameter shows only a Blight variation as 
compared with those of other tribes and nationalities. In 
order that the teeth may come into the arch uniformly, the 
anterior alveolar process is pushed forward. If the anterior 
alveolar process were as unresistible as the lateral alveolar 
proces>. more deformities would result. 

'•That the wisdom-tooth grows smaller a- we ascend the 
scale of civilization is upheld by many writers. But even in 

the lower race-, although the wisdom-tooth doe- not present 
the variations that are found in more civilized races, we find 
that it is far inferior to the teeth of the ape and chimpanzee, 
although among these animals we find the first indication of 
the step toward the degradation and subsequent disappear- 
ance of this tooth.* 

♦Thompson, "Care of the Wisdom-Tooth."* 



74 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

"But the tooth in all these cases is as serviceable as the 
other molars. Among some of the monkey tribes the third 
molar is of equal size to the first and second, while again in 
others it is larger, and in some others is smaller. :: 

•• Mr. Darwin maintains that these teeth are rather larger 
than the other two molars in the orang and chimpanzee. f 

" Mr. C. S. Tomes says: X ' In macaques the third molar is 
larger than the first two, and is qui nquicuspid below; the upper 
quadricuspid. It is generally said that in man the molars 
decrease in size from before backward; that the first molar is 
largest, while in the anthropoid apes the contrary is the case. 
This is true on the whole, but requires some qualification, as 
in the Australian the second and third molars are not smaller 
than the first, and of the chimpanzee the same thing may be 
said to be true. In the anthropoid apes the wisdom-tooth is 
nearly or quite as large as the other molars, and shows no 
variability, while it comes into place almost simultaneously 
with the canine. In the higher apes, such as the gorilla, the 
third molar is in every respect a well-developed tooth, some- 
times even larger than the first or second molar, but instead 
of a spongy, softened crown, it has a crown on which the 
cusps are arranged according to the typical pattern.' He 
also says § that 'the wisdom-tooth (in lower races) has ample 
space to range with the other teeth, and is a characteristic 
molar. In the lower races of mankind the wisdom-tooth 
appears to vary but little, is of large size, and is never mis- 
placed. In the more civilized races it is quite exceptional 
for the lower wisdom-tooth to have the four cusps distinctly 
developed. This is one of the things which pointed to its 
disappearance.' Mr. Mummery says: 'Among the stronger 
African tribes the third molar was always present in the 
lower jaw, but in the enfeebled races it was frequently 
absent.' Professor Allen describes the third and fourth 
molars of an Australian skull, which show a tendency to the 



* Professor Owen. 

+ "' Descent of Man." 

%" Dental Anatomy." 

£ Proceedings of the Odont. Society of Great Britain. 



I ill HKAD, FACE, JAW8 AND TKKTH 

biouspidate type. But Btill more marked differences are 
found between the savage and civilized races than between 
the savage races and animals. In civilized man the degraded 
condition of this tooth in its degeneracy and imperfectioi 
vim\ great, as compared with the nearly perfect condition oi 
the Bame organ in the lower primates 

'• I have shown, in chapter upon alveolar process, that the 
jaw proper and the alveolar process are two distinct struct- 
ures; that thr bone proper was a natural development, while 
the alveolar process depended entirely upon the wedging of 
tin- teeth against each other for it- size and shape. Now, 
these measurements do not accurately -how the deviation of 
the jaw proper in either diameter of the people of the present 
day. The diameter of the jaw Is frequently much smaller 
laterally and antero posteriorly than the diameter of the teeth 
and alveolar process, which every observing dentist can sub- 
stantiate. 

"The average height of vault of four thousand six hundred 
and fourteen measurements was .58 of an inch, while the 
average of two hundred and tifty-one skulls of ancient and 
modern Romans, Indians, etc.. was .;»•',; allowing for the 
thickness of the mucous membrane, the average height of 
the vault of the present people would he a little below that of 
the Indians, negroes, ancient Britons and Romans. 

"In investigating the subject of the effects of disuse of 
the jaw upon its development, one's attention is naturally 
directed to the results arising from disuse of any organ of the 
body, and I will therefore present to the reader sonic data 
collected by me upon this exceedingly interesting subject. 

M The disuse of the jaWS as the Weapon of attack, evident in 
the large canine- of the male anthropoid ape-, exercised an 
influence in reduction of the size of the jaw itself as well as 
on the teeth. The Xeaudert halo'h I jaw i- a type of jaw from 
the standpoint of the anthropoid apes, and the few weapons 
of the Neanderthal types of man indicate that biting, as 
among rowdies of today, played no -mall part in battle, and 

* Dental Cosmos. 

+ Thompson, "(are of the Wisdom Tooth," etc. 



76 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

particularly in duels for female favor. With the develop- 
ment of weapons of offense this employment of the jaw rap- 
idly fell into disuse. The physiological factors underlying 
this element are similar to those detailed.- 

"The chief agents in causing organs to become rudimentary 
seem to have been disuse at that period of life when the organ 
is chiefly used (and this is generally during maturity), and 
also inheritance at a corresponding period of life. The term 
disuse does not relate merely to the lessened action of muscles, 
but includes a diminished flow of blood to a part or organ, 
from being subjected to fewer alterations of pressure or from 
becoming in any way less habitually active. 

"Rengger attributes the thin legs and thick arms of the 
Paraguay Indians to successive generations having passed 
nearly their whole lives in canoes, with their lower extremi- 
ties motionless. Other writers have come to a similar con- 
clusion in analogous cases. It is asserted that the hands of 
English laborers are at birth larger than those of the gentry, f 

"From the correlation which exists, at least in some cases, 
between the development of the extremities and of the jaws, 
it is possible that, in those who do not labor much with their 
hands and feet, the jaws would be reduced in size from this 
cause. That they are generally smaller in refined and civi- 
lized men than in hard-working men or savages, is certain; 
but with savages, as Herbert Spencer has remarked, the 
greater use of the jaws in chewing coarse, uncooked food 
would act in a direct manner on the masticatory muscles, and 
on the bones to which they are attached.* 

"It is familiar to everyone that watchmakers and engravers 
are liable to be short-sighted, while men living much out of 
doors, and especially savages, are generally long-sighted. 
Short-sight and long-sight tend to be inherited. ^ 

"It is a singular fact that sailors are inferioi to landsmen 
in their mean distance of distinct vision. This is probably 
due to the fact that the ordinary range of vision in sailors is 



* Darwin. 
t Walker. 
; Ibid. 



I ill ill \i». I \< I . JAWS AND TEETH . . 

restricted to the length of the vessel and the height of the 
mast 

•• The inferiority of Europeans^in comparison wii i. »a> 
in eyesight and io other senses, is no doubt the accumulated 
and transmitted effect of lessened use during man} genera 
tions. J Europeans w ho have been brought up and spent their 
whole lives with the \\ild [hdiansdo not equal them in the 
sharpness of their sen-.--. The cavities in the skull for the 
reception of the sei era! sense organs are larger in the Ameri 
can aborigines than in Europeans. This probably indicates a 
corresponding difference in the dimensions of the organs 
themseh i 

"The Mongolians of the plains of Northern Asia are char 
acterized by great breadth of the skulls across the zygoma. 
This follows from the highly-developed sense-organs. § In 
the lower jaw of many pigeons the articular surface is pro- 
portionably smaller than in the rock pigeon, and the vertical 
diameter, more especially of the outer part of the articular 
Burface, is considerably shorter. May not this be accounted 
for by the lessened use of the jaws, owing to nutrition- food 
having been given during a iongperiod to all highly improved 
pigeons 

•( me of the chief factor- conducive to arrest of develop- 
ment of the jaws, and one which acts in a threefold ratio, is 
the want of maxillary exercise. This operate- in the follow- 
ing manner: First, by lack of exercise, the blood, which 
nourishes the bones, i- n<»t carried to the pan: second, the 
blood doe- not carry sufficient material to the teeth, hence the 
enamel formed i- defective, and a- a result we have early 
decay; third, by lack of lateral motion, the mechanical develop- 
ment of the alveolar process is wanting. It ha- been shown 
that the jaw- iA' today are not SO large a-tho-e of prehistoric 

iace-. and that they are steadily growing -mailer. The early 
race- lived upon coarse food, such a- roots, berbs, corn, and 

* B. A. Gould. 
+ Darwin. 

I Rentfger and Blumenbach. 

* Prichard. 



7 V ETIOLOGY OF OSSEOUS DEFORMITIES OF 

uncooked meats. This coarse food required considerable 
mastication in order to be prepared for the chemical changes 
which are necessary before* assimilation can take place. As 
a result of use, the muscles of the jaw were dense and hard, 
and when contraction took place they stood out upon the 
sides of the head like large cords. The bones were well 
developed; they were also of dense and hard structure: the 
processes for the attachment of muscles were prominent and 
large, and the teeth were large and set deep in the alveolar 
process. 

"These physical conditions are noticeable only in those 
persons who use their masticatory apparatus a great deal, as 
tobacco-chewers. and are also seen in public speakers and sing- 
ers. To such an extent has the art of mastication become 
obsolete that the food is now swallowed whole, or in a semi- 
masticated coudition. The muscles have become flabby, the 
jaws more slender, and the processes for the attachments of 
muscles are almost, if not quite, obliterated. The difference 
in the size of the superior and inferior maxillae is a marked 
illustration of the result arising from the use and disuse of 
these bones. It is a singular fact that the greater number of 
irregularities of the teeth occur upon the upper jaw: when 
they are found upon the lower jaw, the irregularities are due 
to local causes. 

"The upper jaw is a fixed bone, and the blood-supply is 
small from a lack of stimulus—/.^., movement, and hence 
arrest of development is marked. On the other hand, the 
lower jaw being movable, more blood flows to the part, which 
thus becomes much more developed. 

"Asa further illustration of the results arising from the 
use and disuse of the upper and lower jaws, I desire to direct 
attention to. the following fact: It is known to all denti-t- 
that the teeth upon the upper jaw are more subject to decay 
than those upon the lower jaw. although the environment of 
the teeth upon the lower jaw, especially the bicuspids and 
molars, renders them more subject to decay than those upon 
the upper. Tomes says:- 'The different teeth are not equally 

*" Dental Surgery," p. 273. 



1 111 III \l>, I \< I . .1 \\\ - \M> I I I I II 

mbjeol to the attacks of caries. In the first place the opw i 
are more frequently attacked than the lower accoi I i 
Dr. Ifagitot In the proportion *t '3:2 whilst the yet more 
comprehensive tables of Dr. Hitchcock rive the rati.. <»t 
1.9:1, or very marly two to one.' A disease which i- becom- 
ing a \<i\ common one among our people, an. I which is in a 
[great measure due to want of proper mastication, i- that 
called • Riggs' disease. 1 The first symptom noticed i- a 
slighl redness along the margin <>t the gums. These after 
ward become swollen and bleed upon the slightest touch: 
thm follow intlaininat ion of th<- peridental membrane, absorp- 
tion <>f the alveolar process, and consequent loss of the teeth. 
I Buch an extent has tin- disease become prevalent, that at 
least ninety five per cent of all people over twenty-five years 

je are thu> more or les- afflicted. Twenty -live ye&Ti 

this disease Was not considered of any importance by the 
dentist, due. no doubt, to its comparatively rare occurrence. 
Today it is giving him more trouble than decay of the teeth. 
because a dentist is frequently called upon by patients who 
have a partial or full set of natural teeth which are quite 
loose in the jaw; aside from this they are sound and healthy, 
and after a certain stage in the development of the dia 
nothing can be done to save them; while on the other hand, 
if decay takes place, by constant filling they can be preserved. 
"These condition- arc brought about by a change in the 
mode of living. Man first began to reduce food by cooking, 
in order to make it more palatable. Root-, herbs, and 
grains were more finely divided by mechanical mean-, and 
thus the labor of the jaws in mastication was lessened. Since 
these early beginnings man ha- studied the art of the prepara- 
tion of food, and today it i- prepared in Buch a manner that 
in most cases mastication is unnecessary. While these 
changes in the preparation of the food have taken place, man 
ha- been modified not only as regards hi- sense of taste and 
appetite, but also in the structure of muscle- and jaws. 
•Surely.' -ays Mr. Carter, in the British .Jo»rn<i/ of I> 

. in speaking of the jaw- and teeth, 'some law of 
God and nature has been outraged to bring upon our children 



s,) ETIOLOGY OF OSSEOUS DEFORMITIES OF 

so dire an affliction.' To such an extent has the sense of 
taste and refined appetite become cultivated, that, at the 
present day. it requires all the skill that cooks are able to dis- 
play to produce dishes free from all of the peculiarities pre- 
sented in the early days of cooking. Thus all coarseness has 
been removed from food, and by the new processes, made 
possible by mechanical as well as scientific discoveries, cereals 
are reduced to the finest of flour, while the hulls, which con- 
tain the phosphates essential to bone-building and also furnish 
the material for mechanical grinding by the jaw, are entirely 
excluded. There seems to be a growing inclination on the 
part of the human race to use that class of food which 
requires little, if any, mastication. This evolution will eventu- 
ally result in the adoption of new T modes of acquiring and 
preparing food, viz: the manufacture of foods in the 
chemical laboratory. Indeed, at the present time many 
forms of food, comprising all the nutritive elements necessary 
to sustain life for the sick, are being prepared in the labora- 
tory. If these foods, prepared in a liquid form, are sufficient 
for the nourishment of children and the sick, it seems reason- 
able to expect that they will soon become the exclusive food 
of the laboring class, and indeed of all classes. Such being 
the case, the art of mastication, which is now at a very low 
ebb, will then become entirely lost. 

"I have shown that when the teeth push their way into 
place they crowd one another laterally. By so doing the 
dental arch enlarges, and the alveolar process develops and 
grows about the teeth. The lateral movement of the lower 
jaw in the act of chewing assists greatly in producing the 
enlargement. The constant movement of the lower against 
the upper teeth causes them (in many cases of irregularities) 
to arrange themselves in their proper places. The teeth of 
tobacco-chewers are rarely irregular. Thus we see that the 
result of the proper mastication of food has brought about 
arrest of development of the jaw, and consequent irregu- 
larity of the teeth. 

u As far as the jaws and teeth are concerned, they may 
exist in each parent in perfect symmetry: in one parent the 



MM III \l>. I \« I . JAWS Wl> I I I I II 



jaws and teeth are large; in the other parent both jawa And 
teeth are small; i>ut each in it* waj ia a normal development 
It', now. the small jan <»t' one parent and the large teeth oi 
iIm- other appear in the offspring, deformity is sure to follow. 
Benedict declares that abnormality oi Btructure predisposes 
t<> disease, and among abnormalities of Btructure In- mentions 
particularly, pathological Length and breadth of the I 
pathological relations of the sutures, asymmetry, and inter- 
calaria. 

"The most convincing proof that one of the great can-.- oi 
abnormalities of the jaws is due to race mixture, is the fact 
that these abnormalities arc not found in a pure race, y.. 
the Chinese and negro races. By examining the figures of 




f***\ 



Pig. 12. Fig. 13. 

the dolichocephalic (Fig. 12), Sarmatic brachycephalic (Fig. 
L3), and the Turanic or extreme brachycephalic (Fig. 14' 
types, it will be seen at a glance bow entirely different must 

l>e the single measurement-, not only of the skull generally, 
hut of the face, and particularly the superior maxillary bones. 
These types represent, t<> a greater or less degree, the Ger- 
man, Slav and Finno -Magyar bkuUs of the present day. 
though it is probable that the differences are not bo sharply 
drawn in living Bpecimens. 

"Anthropologists agree that racial differences and pecu- 
liarities are shown more clearly by the skull as a whole than 
by any other portion of the skeleton. It i- to !><• supposed, 
then, that in a mixture of two races with important cranial 
differences, an attempt by nature t<> mix the type-, without 

* Kranioinetrie und Kephalometrie. Wien, 1888. 



82 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the ability to blend them harmoniously, must result in an 
irregularity or abnormality. This argument is borne out in man 
in the predominance of the cerebral and nervous functions, and 
of the chief individual differences being found in the face, in 
variations as to form, to a certain extent, temperament and 
cranial structure. It is simply a matter of evolution, of 
change and reformation of type. But in civilized com- 
munities the law of survival of the fittest is practically 
annulled. 

" Let us suppose, for example, that a person with the form 
of cranium shown in Fig. 12 be married to one with the form 
seen in Fig. 14. It seems scarcely possible that there could 
be a perfectly harmonious blending of the cranial differences 
in these types, even if both parents were in perfect health, 
and the offspring remain in perfect health throughout infancy, 
which may be said never to obtain in civilized communities. 
And what must be the result if nature attempt to combine 
what may be called the intellectual cranium of Fig. 12 with 
the animal strength of face and jaws of Fig. 14 ? Clearly, 
deformity, or at the least, irregularity. Nature could never 
fit the superior maxilla of Fig. 14 into the face of Fig. 12. 
There is no incongruity involved in believing that she would 
attempt this. The law of inheritance — call it nature or what 
else — that insists upon perpetuating supernumerary digits 
and the like, would not stop at harmless peculiarities, as is 
shown by the distinct inheritance of disease, such as cancer, 
tuberculosis, heart disease, etc. Nor is it too much to assert 
that neuroses, which are distinctly hereditable, are, in a large 
measure, due to abnormalities in the conformation of the 
cranium." 

It would seem, then, that from what has been said and 
from actual measurements of the jaws, that no matter what 
the views of the reader may be in regard to the degeneracy 
of the jaws of the human race, he must be convinced that 
the jaws of the human race are gradually growing smaller. 
Because, when we examine the mouth of an individual, we 
find that the teeth in both jaws are normally developed, it is 
no sign that the jaw is sufficiently large to accommodate 



I III III \l» PACK, i \W - \M> I I I I II 






them. It" we raise th<- lip on the upper jam or depress it on 
the lower, in fullj 50 percent of our patients, and pass t In- 
finger along the alveolar process ;it the :i|>i<«'- of the roots oi 
the teeth, we will find quite a depression. This shows that 
although the j : i w -> are undeveloped, the teeth have wedged 
their waj into place and have carried the alveolar process 
with them, thus demonstrating that those who are in the 
habit of using their jaws freely have the advantage of a 
normal development over those unfortunate individuals who 
do imt masticate their food. 



CHAPTER VII. 

DEVELOPMENT OF THE VAULT. 

The roof of the mouth has received several names from 
different authors; one speaks of it as the arch, another the 
dome, still a third the palate. The word arch, although used 
in its proper place, is so often liable to be confounded with the 
dental arch that one is apt to become confused. Thus we 
frequently read of the V or saddle-shaped arch, and we are 
quite unable to decide whether the writer intended to refer to 
the dental arch or the roof of the mouth. The author has in 
former papers used the term vault to distinguish it from the 
dental arch, and shall therefore continue its use in the pres- 
ent volume. 

The vault of the mouth is made up of the hard palate, the 
soft palate, and the alveolar process. The hard palate con- 
sists of two horizontal plates of bone extending from the 
superior maxillary bone upon either side and uniting at the 
median line, and from the anterior alveolar process in front, 
it extends back on an average of two inches, when it unites 
with the soft palate. The hard palate is composed of six dis- 
tinct parts; two incisive bones, two palate plates of the sup- 
erior maxillae, and two horizontal plates of the palate bones. 
The incisive bones, however, become so firmly united to the 
maxillary plate of bone so early in life that the suture 
becomes obliterated. The period of ossification of the median 
suture varies in different individuals, sometimes as early as 
the third and fourth years, and again as late as the fifteenth 
and sixteenth year. 

The author, in widening the arch by means of a jack 
screw, has opened the suture of the median line in fourteen 
different cases in children from twelve to sixteen years of age. 
This was accomplished by very little pressure, showing that 
union had not taken place; these were all neurotic patients. 

As a whole, the hard palate may be described as a hori- 
zontal partition, or floor, separating the nasal cavity from the 

84 






I ii i HEAD, i \' i . i \w B \n 1 1 i i i i n 

in. M i ill. The anterior pari <>t the palate bone unites with and 
becomes a part of 1 1 1 * ■ alveolar process. The uppei rarfa 
tin- hard palate joins the floor <>f the nasal a, which 

are divided in the center by the anion of the vomer. This 
bone, which is quite thin at it- middle portion and cartilagi 
nous mi the anterior pari, begins i<> thicken as it reaches the 
floor of the nose, at which place it gradually produces a 
smooth appearance, dividing the nostril into two rounded 
arches. 

Upon the palatal Burface it is very uneven. Along the 
median line we frequently And a rough ridge of bone, resent 
bling a section of rope, running its entire length, about the 
size of a 9late pencil. Such a condition is frequent l\ obsen ed 
in Peruvian skulls, t )ut of 228 examined at the Peabody 
Museum, Harvard College, sixteen had this peculiar appear- 
ance. In more modern Bkulls we find knot-, or rough lumps 
<^ bone, at intervals along the suture. Again, we will observe 
a thick band of bone from .25 to .50 of an inch in width, 
extending part way or the entire Length of the suture. This 
thickness, or prominence, commences at the alveolar border 
and becomes the widest at the second bicuspid and first per- 
manent molar, where it gradually narrows to a mere point at 
a line drawn aero-- the vault at the posterior surface of the 
second molar. 

The hard palate varies in thickness in different localities 
and differs in thickness in different individuals. Around the 
edge where it unite- with the maxillary hone and alveolar 
process it is quite thick, and also at the median line; while 
about midway between these two parts the hone i- as thin as 
tissue paper. I have also observed it from .12 to .I s of an 
inch in thickness. At the median line, and just hack of the 
incisor-, we tind a fossa which transmits the anterior palatine 
vessels and naso-palatine nerves. At the posterior surface upon 
either side is a groove and an opening for the transmission 
of the posterior palatine vessels and nerves. Both the upper 
and lower surfaces of the hard palate are covered with mucous 
membrane, which extend- hack ward and unites to form the 
soft palate. Between the two folds of mucous membrane are 



86 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

muscular fibres for the purpose of moving the soft palate in 
different directions. The shape and length of the soft palate 
depends upon the distance between the oesophagus and the 
edge of the hard palate. If the head of the individual is 
dolichocephalic, or long, the soft palate will curve slowly 
backward, thus producing quite a long space between the 
incisor and uvula. On the other hand, if the person possesses 
a brachycephalic, or short head, the soft palate will curve 
abruptly, thus allowing only a short distance in the vault of 
the mouth. I have observed mouths where the head was so 



% 




* 



Fig. 15. 

short from front to back that the soft palate descended nearly 
straight down without the slightest curve. 

The vault, taken as a whole, presents different shapes in 
different individuals. 

The above description of the anatomy of the vault is quite 
sufficient for the purpose of the student. Should he require 
further details, he is referred to the standard text-books. 

NoKMAL DEVELOPMENT OF THE ROOF OF THE VAULT. 

If we will examine the mouth of a child at the fourth or 
fifth year, we will find a well-developed jaw. The curves 
are all graceful in outline, and the contour of the dental arch 



I III lll\l'. PACE) IAWN Wl> l l l I II 

is well formed. This could hardlj be otherwise, for the 
bod that ih»' jaw is growing rapid lj for the purpose of 
accommodating the permanent teeth, and the circle of the 
alveolar process is larger than that of the teeth. 8] 

between the teeth, and therefore crowding cannot take 
place. 

We could not expect to 6nd two vaults alike in h< 
width or contour, although each is normal in itself. We 
shall see in tin- chapter upon the alveolar process, that in the 
development of the jaws we have two structures, the hard, 




dense bone of the maxilla and hard palate, and the Boft, 
spongy bone— the alveolar process. The maxillary bones 
develop and unite at the median line. The contour of the 
top of the vault is now established. It is held in position, 
on the Bides, by the walls of the antrum, supported by the 
malar process and by the anterior alveolar process and max- 
illary hone. In this manner the vault i- held in it- natural 
position. The maxillary bones, like all the other bon< - 
the head, develop in every direction in a general way. until 
the growth is established. Between the period of birth and 
two years when all the temporary teeth are in place) and 
twelve or fourteen year- when all the permanent teeth are 



88 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

in position) great changes take place in the shape of the jaw 
This change is nicely illustrated in Figs. 15 and 16. 

Fig. 15 illustrates the face of a girl, three years of age, 
the bones of the face and head all undeveloped. The 
bridge of the nose is sunken, the upper lip is short, as well 
a- the jaw from the lower lip to the chin. How different 
the appearance of the same girl at thirteen (Fig. 16). While 
the width from cheek to cheek has not changed to any great 
extent, the length of the face from the chin to the top of the 
head is very marked. No part of the face has changed more 
than the lower — from the nose down. This change is due 
partly to the change in the angle of the lower jaw, and partly 
to the development downward of the superior alveolar pro- 
cess. In young life, the lower jaw presents an obtuse angle; 
this gradually changes until at middle life it assumes a right 
angle. In order that the alveolar process and teeth may 
compensate for this change as the second set comes into posi- 
tion, the alveolar process lengthens with the eruption of the 
teeth. This is proven by the location of the mental foramen, 
which is situated at the superior border of the lower jaw 
early in life, and at middle life just midway between the 
upper and lower border of the bone. The same changes 
take place in the upper jaw. This is quite noticeable on the 
sides of the alveolar process at the roots of the first perma- 
nanent molar soon after it has erupted. Upon examination 
(see Plates 1, 2, 3 and 4), we shall observe what seems to be a 
depression, but by a careful examination we find that it is a 
lengthening of the alveolar process. When the crowns of the 
bicuspids are ready to advance, and absorption of the roots of 
the temporary molars take place, there is some irritation in 
the alveolar process. The first permanent molar coming 
into position advances further than the line of articulation of 
the temporary molars, and the pressure of the jaws rests 
upon the first permanent molars. This fact, together with 
the irritation already mentioned, has a tendency to lengthen 
the alveolar process, so that when the bicuspids come into 
place there is a difference in the height of the vault. There 
are plenty of illustrations to show T this development of the 



j III 



\\ l» I I I I II 






alveolar process, and ever] practitioner of dentistry has 
obsen ed tin-. 

One of the most oommon illustrations is thai when th<- 
molar teeth upon the lower jaw have been extracted, the 
molar- upon tin- upper piw (for want of antagonists drop 
ilov d l>\ the lengthening of the alveolar process. The 'lit' 
ference in the height of vault when the temporary teeth are 
in place and when the permanent teeth erupt is nicely illus- 
trated in Fig. 17. This cut Bhows the permanent incisors 
and first molars in place. Note the lengthening of 1 1 1 « - 
alveolar process. In this manner we obtain the difference in 





Pig. 17. 

the length of the face. In those cases where the vault is 
very high, the alveolar process is always very long and thin. 
This change in the alveolar process is nicely illustrated in 
Nos. -1 and 22, Plate 4. ten year-, and in Xos. 32, 33 and 
35, Plate 6, twelve years. In No. 21, Plate 4. the temporary 
teeth have been extracted, and the bicuspids have not 
erupted, while upon the left side the bicuspid is just coming 
through; on this Bide the alveolar process is Lengthening. 
The same is true in No. 22, hut on the reverse side. This i- 
more marked in No-, 32, 33 and :::». The temporary teeth, 
however, remain in the last three cases. The depth of vault 
is also governed by the angle of the jaw. Thus, if from 



90 



ETIOLOGY OF OSSEOUS I >KF< Hi.M II 1 1 > nF 



inherited constitutional disease, such as consumption, syphilis, 
etc., arrest of development of the maxillae should ensue, the 
angle would not change from an obtuse to a right angle. It 
will be noticed that when the mouth is opened the anterior 
part has to travel a greater distance than the posterior part, 
hence either the anterior inferior alveolar process will 
elongate so that the lower incisor will articulate with the 
upper (Fig. 25), or the anterior superior alveolar process will 
elongate to meet the lower incisor and bicuspid (Figs. 117, 
US, 119). Occasionally this will take place in both jaws. 




Fig. 18. 

In either case the superior alveolar process becomes long and 
thin, and the vault is quite high. In cases of arrest of devel- 
opment of the bones of the nose and adenoid growths, when 
it is impossible for the child to breathe through the nose, 
and mouth-breathing is a necessity, the jaws are separated, 
and the teeth not having a resting place, the alveolar process 
elongates and a high vault is almost always noticed; hence 
the reason why imbeciles and all degenerates who keep the 
mouth open, as a rule, have high vaults. The high vaults 
and prominent teeth, and upper alveolar process due to this 



1 III HIM'. I \« I . IAW8 \M> I I I I II '.'1 

cause, are nicely illustrated in Fig. i v . etc. ( hi tb< other 
band, we occasionally aotice the jaws brought closed 

ether. This is due (1) to a short ramus; - to right 
angles of the rami to the bod} of the jaw; irresl of 

development of the alveolar process, and, i to teeth with 
short crowns, or teeth Dot fully erupted. In such oases the 
vault i> low, the alveolar process thick, and usually the lower 
jaw is quite brjoad. The lips pout, the face is -Ik » it and 
broad. Frequently the upper jaw is arrested In its develop- 
ment; the muscles of mastication are very Bet and rigid. 
Such a case is illustrated in Fig. 19. 

The height of the vault, then, i- not due to the roof's 







Pig. li». 

being pushed or pulled up by a pressure exerted through the 
vomer by the development of the Bphenoid bone, nor does 
the shape of the base of the skull in any way affect it. as I 
have already explained. The height is due entirely to a 
growth downward of the alveolar process and teeth. The 

extent of the development of the alveolar process depends 
upon Nature'- becoming satisfied with her architectural 
figures, and harmonizing the jaws, alveolar process, and 
length of teeth. That the distance in height is changed from 
a child to a person of middle life is demonstrated by the fol- 
lowing figures: Thus in .'117 children, under five year- of 
age, before the development of the first permanent molar and 



92 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

alveolar process, the lowest vault measured .17; the highest 
.62, with an average of .42. If, now, we notice the height of 
vaults in children at different ages, we find a gradual advance 
in the height of the vaults until, in 4,614 adult vaults, we 
have: lowest, .21, highest, .84, with an average of .58. It 
will, therefore, be observed that the height of vault develops 
about .25 to .33 in depth after the permanent teeth com- 
mence to erupt. In 908 measurements of the vaults of 
ancient and modern Romans, Peruvians, Sandwich Islanders, 
Mound Builders, American Indians, negroes, etc., the mini- 
mum height of vault was .25. while the maximum height was 
.88; average, .53. By comparing these figures with those of 
modern individuals, the lowest vault is a little higher — .U4 — 
than in modern, and the highest a little higher — .04. The 
average, however, is a little lower than in the modern vaults 
by .05, thus showing that the ancient and pure individuals 
possess more uniform and lower vaults than modern. We 
would conclude, therefore, that the height of the vault 
depends upon the length of the face from the chin to the top 
of the head. So far as the height of the vault is concerned, 
no race, type, sect, or intellect can lay claim to high, 
medium, or low vaults. They all exist in all classes of indi- 
viduals. 

NORMAL VAULT. 

What constitutes a normal vault would be a difficult ques- 
tion to answer. I possess six skulls, obtained under diffi- 
culties from a medical college, and not selected for any par- 
ticular purpose. 

The lateral measurement was made between the roots of 
the second bicuspids, and the anteroposterior measurement 
between the central incisors at a point intersecting a vertical 
line dropped from the posterior nasal spine to the posterior 
border of the palate bone. The height of vault was taken 
from a horizontal line extending from the alveolar process on 
one side to the alveolar process on the oposite side, just back 
of the second bicuspid teeth. 

The following measurements were taken* 



i iii 111 u». i \< i . jAwa \M' 1 1 » i ii 






lunui. UITI HOB. in i'. in «.i .mii. 

1. i n in !m ■ 10 90 Mm II In i ! Mb 

g4 ■ • ,,,,;•■ 

- 
». 

■ = IS 84 
3.12 " = 53.84 " 

N^v l and.". possess \«i\ much the same contour of the 
dental arch, while Nos. i and 6 arc \crv broad, with Bquare 
dental arches. 

Tlie heights of the vault- are all different, although two 
arc tlat. while the others are more or Less rounding. If I were 
to hand you any one «>t these skulls, and ash if it was a nor 
mal vault, you would mosl likely answer yes. Fetal! are 
normal, a- I view them, while Q0 two are alike. 

I have examined hundred- of plaster casts, where the teeth 
were all in a fairly normal position, with similar results. 

Of 372 skulls of Peruvians, California Indians, Mound 
Builders, and American Indian-, the lateral measurement 
varied from 1.12 to L. 75, and the antero-posterior f rom 1.75 
to 2.75, while the height of tin- vault varied from .24 to .7.".. 

Oakley Cole made careful measurement of a number of 
skulls, chiefly in the museum of the College of Surgeons, 
London, England. The >kulls examined fall into two series, 
viz.: those of European origin, and those of mixed ran-, 
with the following results: 

EXAMINATION OF THIBTY-FOUB EUKOPEAJS -Kill-. 

■ 1 II IN WIDTH IN HKL.HI IN 

MIl.I.IMh I hi.-. Mill I 

Maximum .".- 1.". 

Minimum >n M 

^e 19 • 

I \ \mi\ kTIOH "I l lili:n PWO MIXED BKU1 L8. 



B in 
MII.I.IMI 


WIDTH IN 

MII.I.IMI I 1- 1.-. 


HKH.HT IN 
Mii.i.n 


Maximum 


i',.*> 


40 
29 


1> 


Minimum 


13 


i". 


Average 


54.9 





* Taken at second bicuspid. 



94 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

In each of the cases that I have examined, the dental arch 
was in a normal condition. I have also examined the skulls 
mentioned by Oakley Coles, and I have been unable to find 
but few contracted arches in any of them. If, therefore, in 
the examination of thousands of skulls having normal dental 
arches, no two vaults are found to correspond, we must con- 
clude that a normal vault is one where the dental arch is 
regular, and the different outlines possess graceful curves, 
regardless of height, width and length. 

BY WHAT STANDARD SHALL WE MEASURE THE VAULT? 

The width of the vault depends upon two factors: Fiisf, 
the development of the jaw bone proper, and, second^ upon 
the development of the alveolar process. 

Narrow jaws are rarely observed among the early races 
or modern pure races. In the examination of the thousands 
of skulls of early races in the museums of Europe and this 
country, very few, if any, contracted vaults are found. This 
is also true of people who lead a quiet life, as illustrated in 
modern pure races. If the brain is in a healthy condition 
and the child properly nourished, the jaw-bone will develop 
in size sufficiently to accommodate all the teeth when they 
erupt. The teeth will crowd against one another as they 
come into place, and a normal width of arch will be pro- 
duced. If the brain is defective, as the result of some of the 
constitutional diseases, and the jaw becomes arrested in its 
development just before sufficient room had been secured for 
the teeth, they will crowd against one another, the arch will 
become broken, and the V or saddle arch, or some of their 
modifications, will be formed; hence a narrow, contracted 
vault. The amount of contraction depends upon the size of 
the jaw-bone proper; if the bone has become arrested early, 
the jaw being small, the contraction is usually very great. 
The alveolar process depends entirely upon the location of 
the teeth for its shape and size. Occasionally the teeth, 
which are small, arc inherited from one parent, and the jaw- 
bone proper, which is large, from the other parent. In such 
cases the alveolar process will contract until all the teeth 






i ill 111 \i>. FACE, JAW8 IND i i i 1 ii 

antaL'oiii/e. w hen | .-mall anh will he produced. I' ha- 

already beeu shown thai the V and saddle shape arches and 
their modifications are observed as often among low vaults as 
among high ones; just as we have seen liiirli and loin vaults 
in normal jaws. The contraction is due to arrest of develop 
ment of the jaw at the time of the eruption of tin- permanent 
teeth; the vault ma} he high or low, What appears to 
high \ : 1 1 1 1 1 is not iii the height of the vault, but in the width. 
Having now explained the true cause of what appears to be a 
high vault, if we will refer to Clouston's classification, we 
will find what he calls neurotic and deformed are both one 
and the same. Both are neurotic, but one is more contracted 
than the other; both art- due to arrest of development of 
the maxillary bones. In summing up our observation, we 
find that there arc high and low vault- among the ignorant 
as well as the intellectual, among the colored as well as the 
white, among the brachiocephalic and mesocephalic as much 
as among the dolichocephalic, among the deformed, or con 
traded, as much as among the normal. The width of the 
vault depend- upon the development of the maxillary bones; 
if it develops to a size sufficient to accommodate all the per- 
manent teeth, it will be a normal vault, regardless of height. 
On the other hand, if arrest of development of the jaw take- 
place, these deformities result in a V or -addle arch or some 
of their modifications. How, then, shall we classify vaults? 
In the measurement of the height of vault- of 8,654 ancient 
and modern -kull- in this country and Europe, the highest 
was . Nv . the lowest, .25, with an average .53. In the meas- 
urement of 6,387 mouths of living people over twenty years 
of aire, the highest is .84, the lowest .21, with an average of 
.58. In the measurement of 616 insane people at the East- 
ern Illinoi- In-ane A-ylum, the highest 18 1. lowest .12, with 
an average of .54. 

Taking these figures into consideration, it i- safe to aver- 
age the height at .55. Allowing .15 of an inch in each d 
tion. we can call vaults which measure below .4" low vault-: 
those between .40 and .70, medium vaults; those abov< 7 . 
high vaults. We could still classify tho-e below .25 verj 



96 ETIOLOGY OF OSSEOUS DEFORMITIES 

low vaults, and those above .85 very high vaults. The 
width of vault between second bicuspids 
In 8,054 ancient and modern skulls: 

Maximum, 1.63 

Minimum, - - 1.13 

Average, - - - - 1.36 

In 6,387 mouths of living people over twenty 
years of age: 
Maximum, - • - - 1.50 

Minimum, - - - .93 

Average, - - - 1.19 

In 616 insane people: 

Maximum, - - 1.87 

Minimum, - - .75 

Average, - - - - 1.16 

The vast difference in the ancient and modern skulls of 

this country and Europe, with those of living individuals, 

shows conclusively that the jaws are diminishing in size. 

We must, therefore, arrange a standard by which we are to 

compare the width of the vault as we find them today, 

excluding measurements of ancient and modern skulls and 

deformed jaws. Taking the 1.19 as the average width of 

vault, we will say that any jaw below 1 is a narrow vault; 

one between 1 and 1.40 medium width, and one which 

measures above 1.40 a wide vault. 



CHAPTER VIII. 

DEVELOPMEN I OF THE AL\ I .< >L \i; PR( >CESS. 

The alveolar processes are Bituated upon the superior 
border of the inferior maxilla and upon the inferior border of 
the superior maxilla. These bones are considered a pari of 
the maxillarj bones, and are so described by anatom 
They should, however, be considered and described aa prac 
tically separate and distinct bones. Their structure and 
functions differ so completely from the structure and func 

tions of the maxillary hones that there is little or DO simi- 
larity between them. The superior and interior maxilla' are 

(unlike the alveolar processes composed of hard, compact 
hone -tincture The Large, powerful muscles attached to 
them would indicate that powerful work is to be accom- 
plished, and when fully developed they retain their full Bize 
through life. The alveolar processes are composed of soft 
and spongy hone of a relatively cancellous structure. A- 
early as the eleventh week of intra-uterine life, calcification 
of the deciduous teeth commences, and by the twentieth 
week calcific material is quite abundantly deposited. I 
tication is also rapidly progressing about the dental follicle-. 
At birth the sacs are nearly or quite enclosed in their soft, 
bony crypts, and the crowns of the teeth upon their outer 
surface are composed of enamel, which is dense and hard. 

The alveolar process, being soft and Bpongy, mold- itself 
about the sacs containing the crowns of the teeth and about 
their roots after their eruption, regardless of their position 
in the jaw. While the alveolar processes have grown rapidly, 
they have, up to this time, developed only sufficiently i<> 
cover and protect the follicles while calcification proceed-. 
When the crowns have become calcified and the root- have 
begun to take in their calcific material, absorption of the 
borders of the processes take- place in the order of the erup- 
tion of the teeth. When the teeth have erupted, the alveolar 
process develops with the teeth until they attain the depth 



98 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



of the roots of the teeth, which extend in most instances into 
the superior maxillary bone, in the anterior part of the mouth 
at least. The depth to which they penetrate the bone differs 
in different mouths. The incisive fossa^ the ccmine eminence 
and the canim fossa give evidence of this externally. These 
sockets are lined with extensions of the process, thus making 
its upper border irregular. The fact that some of the teeth 
are fixed in the bone as well as in the alveolar process makes 
the correction of some forms of irregularity more difficult, 
for not only does the process have to be reshaped, but the 
bone as well. This is quite noticeable in correcting irregu- 
larities of the teeth in the lower maxilla. The crypts of the 
permanent teeth are located at the apices of the roots of the 
temporary teeth. The permanent teeth have large crowns 




Fig. 20. 

which touch each other, forming a line to the posterior part 
of the jaw. These teeth, as they erupt, entirely absorb the 
alveolar process which surrounded the temporary teeth, and. 
as the new set come into place, a new process is built up 
about them for their support. The permanent teeth require 
a deeper alveolar process to support their roots, which are 
much longer than those of the temporary teeth. Hence the 
difference in the depth ol the arches of the first and second 
sets of teeth. 

The alveolar process of each superior maxilla includes the 
tuberosity, and extends as far forward as the median line of 
the bone, where it articulates with the process upon the 
opposite side. It is narrow in front, and gradually enlarges 
until it reaches the tuberosity, where it becomes rounded. 

If we examine the two articulated superior maxillary 



i ill HEAD, i v « i . i \\\ - \m» i i i I ii 

bonea l we sec that the anterior pari is ourved, while 

tin* posterior part gradually diverges from the central line of 
ossification of the maxillarj bones. The Bhape varies in dif 
ferent individuals. Some arches are small and others large; 
tlif arch is parabolic in some oases and circular in others. 

The process is composed of two plates oi bones, an outer 
and an inner, which are united at intervals bj Bepta of can 
callous tissue. These form tin- alveoli for the reception oi 
the roots of the teeth. En some cases the buccal surfaces of 
the root- of healthy teeth extend nearly or quite through the 
outer body plate. 

This plate is continuous with the facial and zygomatic 
Surfaces o\ the maxillary hone. The inner plate 18 thicker 
and stronger than the outer, and is fortified l>y the palate 
bones. The external plate is irregular upon the outer but 
face, prominent over the roots of the teeth, and depressed 
between the root- or interspaces. 

The prominence over the canine teeth, called the canine 
eminence, i- very marked, and decidedly modifies the ex] 
-ion of the face. The sockets of the central incisors are 
conical and round: those of the lateral incisors conical and 
slightly flattened upon their mesial and distal surfaces, and 
not bo large a- the central sockets. 

The pit for the cuspid i- conical and much larger than 
any of the other sockets. The sockets for the bicuspids are 
flattened upon their anterior and posterior surface-, and near 
the apex they are frequently bifurcated. The sockets of the 
molar- are Large at the openings, hut at about the middle of 
their Length they are divided into three -mallei 1 sockets for 
the reception of the root-. In the case of the third molar 
the number of sockets ranges from one large cavity to three 
or four of smaller size. 

THE ENFEBIOB \l.\ EH >LAB PRO* B88 

The alveolar process of the inferior maxilla extend- from 
the ramus of one >ide to the same point on the other. The 
outline i- similar to that of the superior process, the anterior 
portion being much thinner. 



100 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

The description given of the structure of the superior 
process will also apply to the inferior. The outer plate of 
bone opposite to the molars and bicuspids is thicker than the 
inner plate, while the inner plate opposite the canines and 
incisors is thicker than the outer. 

The alveoli are arranged along the border of the bone for 
the reception of the roots of the teeth. They correspond in 
form to the roots which they accommodate. The alveoli for 
the central incisors are smaller than those for the lateral. 
They are conical in shape, and flattened upon their mesial 
and distal surfaces. Those for the lateral incisors are 
larger, and compressed on their mesial and distal surfaces. 
The sockets for the canines (cuspids, or stomach teeth) are 
larger, deeper and less compressed than those for the incisors. 

The sockets of the bicuspids are considerably flattened 
upon their lateral surfaces, and are sometimes divided into 
two cavities. The sockets for the anterior roots of the molars 
are broad and flattened laterally, while those for the posterior 
roots are round. The third molar, being naturally of varia- 
ble form, has sometimes one pit, and again three or four. 
Each alveolar pit or socket is divided from its neighbor by a 
small wall or septum, which is made up of cancellated bone, 
extending about one-eighth of an inch above the inner and 
outer plate. 

The dental septa assist in keeping the teeth firmly in their 
places. 

It will be observed that the septa are very thin at the 
margin, and gradually increase in width to the middle of the 
jaw, where they become thicker, and are finally lost in the 
substance of the jaw. Some septa are thicker than others, 
and where two teeth are widely separated, the width of the 
septa naturally corresponds to the space between the teeth. 

The sockets are lined with a thin plate of compact bony 
substance, extending from the outer and inner plate of the 
alveolar process to the apex, where there are small openings 
for the entrance of nerve and blood-vessels for the nourish- 
ment of the teeth. 

This bony plate has upon its inner surface the elastic peri- 



KACK, i \w - W l' 1 I I l II 



lOl 



dental membrane, which acts as a cushion for the teeth, 
while upon the inner surface it is surrounded bj Bpong} 
bone. 

The teeth are held firm in their alveolar sockets by a union 
called ur * ' ii » j » 1 1 « » - i - . which resembles the attachment of a nail 
in a board. Teeth with one conical root, and those with two 
or more perpendicular roots, are retained in position bj an 
i adaptation of the tissues. Teeth having more than one 
root, and those bent or irregular, receive support from all 
sides by reason of their irregularity. The teeth are also held 







in position by the peridental membranes. Fig. 21 illustrates 

the position of the teeth in the jaw-. The peridental mem- 
brane line- the alveolus and cover- the root- of the teeth. It 
i- a fibrous tissue, which admit- of a slight motion of the 
teeth, and act- a- a I u-hion to protect the jaw- from severe 

blows and concussions while in the act of tearing and grind- 
ing food. 

After the removal of t In* permanent teeth the alveolar pro. 
cess i- entirely absorbed. Fig. 22 -how- how absorption takes 

place. The teeth have all been removed from the superior 
maxilla, as ha- also the alveolar process. The molar- on the 
lower jaw have been extracted, and absorption of the alveolar 



102 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



process has resulted, showing a marked contrast in connec- 
tion with the anterior alveolar process, which remains intact 
and holds the teeth tirmly in place. Thus it will be observed, 
from the changes which occur from the first development of 
the teeth to their final extraction, that the alveolar process is 
solely for the purpose of protecting the teeth in their crypts 
during their development and after their eruption. When the 
temporary teeth are in place the alveolar process remains 
unchanged (except a gradual enlargement in harmony with 
the growth of the maxillary bones) until about the sixth year, 
when the second set of teeth appears. The crowns of the 




Fig. 22. 

permanent teeth require more space than those of the tem- 
porary set; and the alveolar process must necessarily enlarge 
to accommodate them. This enlargement of the alveolar pro- 
cess is doubtless caused by the formation of the crowns of the 
permanent teeth before eruption, and to a limited extent by the 
growth of the maxillary bones, which may cease developing 
at any period in the life of the individual, or continue as late 
as the thirty-sixth year. The diameter of the crowns of the 
permanent teeth forming a larger circle than that of the 
maxillary bones, the alveolar process must necessarily increase 
its diameter. It is often forced outside of the superior 
maxilla by the crowns of the permanent teeth crowding and 



VWS \\ I 



103 



ag themselves into positions anterior to the first per 
manent molar teeth. This enlargement ol the alveolar pro 
cess usually takes plaoe anterior to the first permanent molars. 
We expect to find the process corresponding in size to the 
jaw-. Fig, 23 shows a comparatively small superior maxilla, 
the inferior being much larger. This is the result of arrested 
development, inoluding thcT bones of the face. To allow for 
the deficiency in bone-structure, and a 1 1< >w the upper teeth to 
extend over the lower, the upper teeth have forced the alve 
olar process forward. The -pace shows where a tooth was 
extracted after all the teeth wen' in position. The teeth of 




Pig. 23. 

today are nearly if not quite the size they were 3,000 years 
ago; on the other hand, the jaws are growing smaller. To 
compensate for this difference, the alveolar process has to 
expand, or enlarge, to allow the teeth to come in evenly. If 
the teeth antagonize uniformly the arch will enlarge around 
evenly. If the molars are fixed the alveolar process will 
expand anteriorly. Again, if the teeth should not antagonize 
evenly, a break will take place at that point, producing a 
V or saddle arch. 

Fig. 22 shows a similar case where all the upper teeth have 
been removed and absorption has entirely obliterated the 
alveolar process. The relations of the superior maxillary 



104 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



bones to the alveolar process and teeth on the lower jaw are 
well illustrated. When the alveolar process and teeth were 
intact they presented an appearance like illustration No. 23. 
The position and shape of the processes and their relation 
to each other are governed entirely by the location and size 
of the teeth and roots, and not by the shape of the jaw-bone 
proper. The dental follicles containing the crowns may be 
located upon the outer border of the jaw-bone on one side, in 
which case the alveolar process will be situated upon the 
outer border, and assume an irregular arch. If the crowns 
of the teeth are located upon the inner border, or if one jaw 
be smaller than the other, the teeth will articulate and the 




Fig. 24. 

process will form a smaller circle than the jaw-bone proper. 
Such a case is illustrated in Fior. 24. The superior maxilla 
is much larger than the inferior, and, as a result, the articula- 
tion of the teeth and the muscles of the cheeks and lips have 
carried the teeth and alveolar process on the upper jaw 
inward. The teeth on the lower jaw are regular and appear 
to have sufficient room, while those upon the upper jaw are 
crowded and overlap each other. The teeth on the left side 
of the upper jaw are more regular than those on the right 
side. Upon examining the mouth, or model, the arch on the 
left side will be found full and regular, while the arch upon 
the right side has a perfect semi-V-shape. 

The alveolar process on the right, side extends considera- 



MM IIKAI). KACK, JAWS \M> I I I I 11 



lOi 






i.lv over the border of the maxillarj * »« » ■ 1 * - . and the teeth 
(especially the cuspid) have taken quite an incline In order t" 
articulate with the teeth upon the lower jaw, thus crowding 
the alveolar process to the inner border of tin- maxillary 
bon< 

The process is solely for retaining tin- teeth, and if for 
;ui\ reason the dental follicles should nol be present and the 
tooth Bhould not erupt, or if it should have been extracted 
early, the process would nol be developed at that point In 
m\ collection of models may be seen cases of arrested -lev. 'lop 
menl of the alveolar process, caused by the lack of biouspid 
and lateral inoisor germs, and by the extraction of the decid- 
uous and permanent teeth. 




Fig. 25. 

If one or more teeth should not antagonize, the alveolar 
process would extend beyond the natural border, carrying 
the teeth with it. A marked illustration of this is seen where 
the molars are decayed to the gum and the roots remain. 
The vascularity of the process is such that its development 
results. Excessive development of the alveolar process is 
frequently observed by every practitioner in connection with 
the anterior inferior teeth. When the articulation i- normal, 
occlusion of these teeth never takc> place. We frequently 
find (especially in patients from -i\ to twelve year- <>\ age) 
these teeth extending to and occluding with the mucous 
membrane of the hard palate, making one of the most diffi- 
cult forms of irregularities to correct. Such a case is illus- 



L06 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

trated in Fig. 25. This model is taken from the jaw of a 
person thirty-seven years of age, but I venture the statement 
that this excessive development took place between the ages 
of six and twelve, because at that period the vascularity of 
the tissues is more vigorous and the development of the pro- 
cess more formative than at any period subsequent to the 
development of the first permanent teeth. 

I recall a case in practice in which the incisors and cuspids, 
together with their alveolar process, were situated upon the 
external surface, while the bicuspids, molars and their 
alveolar process are located upon the inner border of the jaw. 
Another case is one in which the alveolar process failed to 
cover the roots of the bicuspids and molars upon the outer 
surface, the teeth having forced themselves into a larger cir- 
cle through the alveolar process by the contact of the crowns. 
The roots in this case can be easily outlined by the finger 
through the mucous membrane; the outer plate of the 
alveolar process barely, if at all, covering them. Mr. Tomes 
mentions and illustrates a case in a late work, of faulty develop- 
ment of the outer plate of the alveolar process exposing 
the crowns of all the temporary teeth. The case was a child 
who had suffered from hydrocephalus. I have a number of 
models showing the anterior alveolar process projecting 
beyond the normal position by the forward movement of the 
molars. This may be due to a natural movement of the 
molars forward, or the process may be forced forward by the 
improper occlusion of the jaws. The teeth are moved from 
one position to another simply by the force consequent upon 
absorption and deposition of bone. This is noticeable in the 
spaces between the centrals, when the alveolar process 
develops to a larger circle than is necessary to accommodate 
the teeth. The alveolar processes are influenced in one direction 
or the other by the pressure of articulation. This abnormal 
condition is the result of inharmonious development of the 
jaws. The teeth may come together in such a manner as to 
throw the alveolar processes either to the right or left, thus 
producing a full round arch upon one side of the jaws and a 
perfectly flat or straight arch upon the other: (See Fig. 24.) 



I III III \l>. FACE, JAW8 AND TEKTII I". 

Tlic greatest deformity is that in which the teeth of the upper 
jaw and alveolar process are forced forward, causing i pro 
traaion of the anterior superior part of the month. (| 
sionally n\c find both upper and lower alveolar proc< -• car 
ried forward in the Bame manner. The alveolar process upon 
the lower jaw is more liable to be found upon t h«- inner bor 
der of the jaw than is the upper alveolar process, as the 
interior maxilla is larger an«l more dense than the Buperior, 
and wh.n the teeth arc once in position upon the lower jaw 
they arc not liable to subsequent change. A- the jaws 
become smaller and more delicate, the anterior alveolar pro- 
cess becomes thinner and less liable to resist the forward 

movement of the molar and cuspid teeth, thus producing ante 
rior protrusion and V-shaped irregularities. Owing to this 

fact the teeth of the superior maxilla do not form so great a 
circle, causing the teeth upon the Bides of the jaw- to conflict 
and the lower teeth and alveolar processes to he carried in- 
while the anterior teeth of the lower jaw are held inside of 
the superior anterior teeth, thus carrying the alveolar pro- 
cess inward. 

The teeth are continually changing their positions in the 
mouth. This is beneficial as often a- it is detrimental. Thai 
the teeth may perform their full function, they should not 
only remain firmly fixed in the alveolar process, but they should 
also antagonize. The teeth may he compared to the bricks 
in an arch: remove a brick and the arch falls to pit 
It is frequently found that the teeth do not articulate prop 
erly, and by cutting away the approximal surfaces a better 
articulation may he secured. When this operation i- per- 
formed the teeth move in their BOckets by absorption and 
deposition of bone, demonstrating the fact that the pn 
changes in Bhape and substance. 

The tendency of the alveolar process to develop between 
the sixth and twelfth year i- something marvelous. This 
seems to he the period ^f it- greatest activity. 

Physiological excessive development, however, is governed 
entirely by the eruption of the teeth. The air passages may 
become tilled by excessively developed hone- or mucous mem- 



L08 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

brane, by adenoid vegetation or other causes; as a result 
mouth-breathing will take place. 

The lower jaw drops, and the pressure is taken away from 
the teeth. 

In idiocy, and imbecility, and other degenerate conditions, 
mouth-breathing is also very common. 

In these cases we find a long, thin alveolar process. The 
teeth continue to erupt, and the alveolar process elongates. 

Occasionally when the mouth is closed the six anterior 
teeth will elongate, and the lower incisor will penetrate the 
superior alveolar process. 

In such cases the superior incisors protrude and separate. 
This deformity will continue until the upper incisors cease to 
develop, owing to the pressure of the alveolar process upon 
the lower incisor teeth. 

If, now, we wish to correct this deformity the first thing to 
do is to place a plate in the mouth, to allow the lower 
incisors to rest upon the plate. 

In this manner the pressure is taken from the bicuspids 
and molars. In two or three weeks' time the posterior teeth 
and alveolar process will elongate from .12 to .16 of an inch; 
thus showing the possibility of the development of the alve- 
olar process in a short time by removing the pressure. 

In some cases this excessive development of the alveolar 
process goes on very rapidly, especially in the case of 
an epileptic. 

This, however, takes place at the time of the development 
of the first teeth. 

HYPERTROPHY OF THE ALVEOLAR PROCESS. 

From what has already been said of the vascularity of the 
alveolar process, we may expect to find hypertrophy of the 
tissue ensuing from simple irritation of varying degree. The 
irritation consequent upon the eruption of the teeth, together 
with the excessive blood-supply, are both primal causes of 
over-building of tissue, i. e., hyperplasia. 

The ragged roots of the temporary teeth, produced by 
absorption, the gases from the putrescent -pulps, and the 



I III 



III' \l '. I \< I 



.1 \\\ 



AMi III III 



|m;» 



pressure of the permanent crowns against the tissues, produce 
sufficient stimulation to excite physiological action. Tissue 
building generally is seen in connection with the teeth pos 
terior to the cuspid, rather than with the teeth anterior to 
thai tooth. Ii Beemfl accountable onlj from the fact that the 
incisors have sharp cutting-edges, the roots of the teeth are 
single and nearly always shed before the permanent teeth arey 
in place, and the] erupt at an age when there is less vitality. 
Pi r contra, the crowns ^i the teeth posterior to the cuspid are 
broad, the roots of the temporary teeth posterior to the 
cuspids are more numerous than those anterior to them, and, 
with the exception of the first permanent molars, they erupt 




at the age of greatest vitality. Epileptics of all the degene- 
rates arc the class who possess these stigmata. Excessive 
development of the alveolar process is unusually common 
among them, a- is also the case \\ ith the muscles of the body. 
Hie process becomes unnaturally thick, the bicuspids and 
molars arc carried in one direction and another, effecting a 
variety of irregularities. I have frequenty observed hyper- 
trophy in connection with epilepsy. Hns i- owing t<> the 
unstable tissue-building, a- noticed among degenerates. A 
common form is shown in Fig. '^>. Similar irregularities are 
also Been in Cole's "Deformities of the Mouth." Figs. L2, 1-"', 
and -J 7: and in Tome-' "Dental Surgery," Fig. '• , ". These 



11" ETIOLOGY OF OSSEOUS DEFORMITIES 

deformities all take the contour of the saddle-shaped arch. 
This may be accounted for from the fact that the permanent 
molars, being the first teeth to erupt, become fixed before 
the deposit commences. The crowns of the bicuspids are 
also held in a small circle by the retention of the temporary 
molars. When these teeth do not antagonize they are liable 
to be carried inward. 

The cuspids, with their long roots, meet resistance either 
in connection with the teeth adjoining or with those upon the 
opposite jaw, and are thus held in position. It will be 




observed that, in all of these cases, the enlargement seems to 
be associated with the inner plate of the alveolar process. 
My observation in these cases has been that with most of 
them the inner plate is the part of the alveolar process 
affected. The outer plate, although quite irregular from the 
arrangement of the teeth, is usually normal in thickness. 
This disparity in the two plates of the alveolar process may 
be accounted for from the fact that the inner plate of the 
alveolar process possesses a large blood-supply— the posterior 
or descending palatine arteries furnishing the ossific material. 
The author has observed a few cases where the hypertrophy 



i ill HEAD, FACE, JAW8 AND TEETH 111 

baa extended to and included the outer plate. When the 
outer plate beoomea invoh ed the ah eolar pi 
rerj thick condition. Occasionally, hypertrophy will affect 
one side only or one distinct locality. Fig. 2? illustrates such 
8 case. In this case the enlargement is upon the lefl side and 
extends from the first bicuspid posterior to, and includ 
the maxillary tuberosity . Instead of the force h«i mr directed 
inward, as is generally the case, the process is forced out- 
; and backward. This enlargement occurred previous to 
the development of the Becond and third molar-. The alve 
olar process extends downward and occludes with the teeth 
upon the lower jaw, thus preventing the molar- from erupting. 



CHAPTER IX. 

DEVELOPMENTAL NEUROSES. 

Dr. Langdon Down, of the Earlsworth Asylum (London), 
first called the attention of the profession, in 1871, to the 
fact that after observation of the mouths of a large number 
of congenital idiots, he found that in nearly every case there 
was a contracted arch at the second bicuspid region and an 
inordinate vaulting of the palate, and that irregularities of 
the teeth were very common among this class of patients. 
Dr. W. W. Ireland, in continuing this, says that by an exam, 
ination of the mouths of eighty-one congenital idiots, he found 
two cases of cleft palate and thirty-seven deeply vaulted, keel 
shaped palatine arches." Dr. Kingsley examined the jaws of 
200 idiots on Randall's Island, but found very few con- 
tracted arches at the bicuspid region, and no case of pro- 
nounced V-shaped arch. Drs. J. W. White and Stelwagen, 
after an examination of one hundred and eighty- four idiot 
children, found that large and well-formed jaws were the 
rule, and that idiots would "compare fair in this respect 
with the same number of similarly neglected people of ordi- 
nary intelligence." Dr. Kingsley concludes that " taking the 
idiots as a class and comparing them with the lower order of 
society, as found in this country, there were no more irregu- 
larities in the one than in the other." 

Such seemingly conflicting reports by men of equal abil- 
ity in their several specialties upon both sides of the Atlantic, 
led the author to take up the special study of the etiology of the 
deformities of the jaws and teeth, in 1S81, with a view of 
obtaining the true cause, if possible, of the abnormal condi- 
tions. This desire was strengthened by the fact that he had 
observed, like Dr. Kingsley, marked deformities (but per- 
haps not so many) among some of his best patients (well-to- 
do people), and bright business men and women. It was 
thought best to examine the jaws of the idiots first and study 

*British OdoDtological Society's Trans., 1871. 

112 



nil HEAD, FACE, JAWS AND TEETH 118 

the Bubjeol from that standpoint. Tin- result ol this inv< 
gation was b paper read before the rnternational Medical 
Congress, held in Washington in i ss 7. in which it is noted 
that onlj i- cent of .ill the inmates of the asylum 

examined possessed normal jaws. Subsequent Btudj and 
investigation i»\ the author has Bhown that all defective 
classes possess an unusually largi Dumber of deformities of 
the jaws and teeth, and a little later he published in The 
Dentaj Cosmos Ihe result of his investigations. It nom 
seemed necessary to take up the Bubject of the development 
of the brain and its diseases, with a view of tracing the dif 
ferent mental conditions of those Buffering with deformities. 
An oral report of this work was accepted as a thesis for 
admission to the Chicago Academy of Medicine, in L890. 
Before taking up the subjecl in detail, a paper written by 
Mr. Uartwright, bearing upon these point-, will furnish a Buit 
able text for some remarks. Mr. Cartwright, inapaperread 
before the Odontological Society of London, Ma\ 2, 18 
among other things, remarks; " [rregularity is common in most 
highly civilized communities, and especially bo among the 
upper and middle classes, and it is more constant among the 
inhabitants of town- than it is among the inhabitants of agri- 
cultural districts. Now, it appears to me to be 
a question of much interest and importance to consider 

whether the form and size of the jaw- in civilized countries, 

in some instances, may not be accounted for as resulting from 

a process <>\' breeding. We know that with animal- and 
birds what is called high breeding i- arrived at and main- 
tained by the constant selection of birds and animal- poss< — 
ing particular point- and characteristics; and Mr. Darwin 

ha- Bhown, and Mr. Huxley and other- have added the 

weight of their sanction to the truth of Mr. Darwin's facts, 
that with birds— take the pigeon, as he has. a- an example — 
by selective breeding the hone- as well as the plumage, 
become altered, and changed from the original type. 
Thus, we may reasonably argue, that -mall jaws may 
he characteristic of breed in certain conditions of life, or 
may express symptoms of deteriorated growth, under some 



11 ± ETIOLOGY OF OSSEOUS DEFORMITIES OF 

circumstances of society. And whether it be high breeding, 
or close breeding (I mean where marriages of near con- 
sanguinity occur and recur), diminished capacity in the jaws 
is generally a prominent feature, and irregularities of the 
teeth a common phase. 

"What constitutes high breeding? Is it not selective 
breeding confined principally to a particular class or classes ? 
Take the aristocracy and families who date their names and 
descent from antiquity, who, as a rule, intermarry among 
themselves, from political or family reasons, and to a more 
modified extent, other classes of the community-modified 
because they represent much greater numbers — and I am con- 
vinced that we find, as a result of that selective breeding, 
peculiarities of form and organization not differing from 
what we find to be the case with high breeding among ani- 
mals, which is maintained by the constant and careful selec- 
tion of animals possessing particular points and character- 
istics. Take the horse and consider the points which make 
up a thoroughbred animal. The small head and ears, the 
thin legs, small fetlocks and feet, the necks and bodies finely 
and symmetrically proportioned, and then the narrowness and 
comparative smallness of the maxilla?. 1 ' 

Within the past few years great advancement has been 
made in differentiating the various forms of insanity, but even 
now classification is admittedly imperfect. Patients admitted 
to public and private insane hospitals do not, as a rule, 
bring with them complete and reliable data as to the causes 
of their malady. While the attending physicians may be 
generally anxious to obtain a very accurate anamnesis of the 
case, the patients and relatives are loth to answer questions, 
or through ignorance are unable to answer them correctly. 
In public institutions especially, it is often impossible to get 
at a true history of the previous condition of the patient. 
Alienists have, however, been able to classify certain marked 
forms of insanity and degeneracy, so that other specialists 
can, from their standpoints, add materially to knowledge 
already obtained, and by putting together the different frag- 
ments so obtained, eventually derive facts of scientific value. 



1 111 head, Page, jaws and teeth 115 

The -tud\ of 1 1 m - human hody ha- heron.. .1 BO 

complicated, that no one individual can grasp the whole, i>ut 
by becoming proficient in some one specialty, be can add 
materially in solving the great question of cause by adding 
bis mite to the grand total. Alienists have divided certain 
conditions of the brain into two great classes Deurotica and 
degenerates. 

A neurotic is one whose brain and nervous bj Btem (spina] 
and peripheral nerves included) are unstable from acquired 
taint, or often from inherited tendencies. 

A degenerate is a being who lias imperfectly undergone 
the changes from a higher to a lower type in i issue or organs. 

Author- and specialists differ in regard to these defini 
tions, an. I also differ a- to the cases that should come under 

the bead of one and the other. The inherited element in 

both leads to this confusion, especially a- the neurotic at 

most has often hut latent heredity. 

The doctrine <>t* degeneracy, explanatory of these condi 
tions, may i»e tersely stated a- follows: There are local 
degeneracies of tissue function, but this is not the -ense in 
which the term is used by the disciples of Morel, the founder 
of the doctrine of human degeneracy. As Morel and his 
later disciples have shown, alcoholism, skull fracture. Bpinal 
diseases, etc., in the ancestor may produce an hereditary 
taint showing degenerative stigmata in the child. Degener 
acy is used in the evolutionary sense as implying an atavism, 
which necessitated at Least two generations. The doctrine of 
evolution i- that everything proceeds from a simple homo- 
geneous to a complex heterogeneous with a Loss of expendi- 
ture of force. Thus, in the nutritive reversions, a tissue 
may. by degeneracy, regain a power of reproduction which 
it had in the foetal state, such reproduction extending beyond 
mere repair. Vertebrates never, or rarely, reproduce lost 
limbs, while the phenomenon i> far from infrequent in 
invertebrates. This condition of degeneracy underlie- cer- 
tain tumor-: reproduction exceeding a required rate i^f 
repair. Cohnheim is of the opinion that this tendency under- 
lie- all cancer formation, hut later researches somewhat mod- 



110 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

ify this view. Degeneracy, furthermore, implies a latent 
instability of tissue which constitutes the hereditary predis- 
position to disease exemplified in neurotics, as well as other 
systemic diseases. All these may present stigmata or signs 
of degeneracy; most frequent and numerous in the intellect- 
ual and ethical atavism, and least in the nutritive atavisms, 
spinal degeneracies and local reversions. The nutritive ata- 
visms may appear as stigmata in the other types, and so may 
the spinal and local reversions. 

Degeneracy may involve the entire system, or only a part, 
or merely a function of a part. Gout is the reversion of a 
mammalian liver to an areptilian function. Degeneracy may 
seem to be acquired, since it appears only at the periods of 
involution, or at the periods of evolution, but the degeneracy 
is in the tissue instability present, which is not evoked until 
the epochs of stress on function. Weissmann denies transmis- 
sion of acquired defect, but his attempt to explain hereditary 
epilepsy on any other theory fails completely. He charges 
epilepsy to microbes, but admits that it may be produced in 
the first generation by non-microbic agencies. There is 
no proof existent of the microbic origin, and Weissmann's 
explanation fails, as Eimer has shown. 

Weissmann. however, admits (which emphatically settles 
the question) that disturbances of the nutrition of the ovum 
may cause the inheritance of acquired defect. He there- 
fore admits that acquired defects sufficient to affect the nutri- 
tion of the ovum can be inherited. 

The following table represents the views of the lucid, 
logical disciples of Morel: 






I III III \l>. I \» I . JAWH \M> I I I I II 



1 17 



Ethical 

I >e<renerac> 



Cerebral. < 



[ntellectual 
Degeneracy 



( i niif. 

E > ro8titution and Sexual I tegeii 

eracy. 
M iral I nsanity, Pauperism and 

I oebriety. 



[ntellectual I tageneracj 
Paranoia. 

Adolescent Insanity . 
Periodical [nsanitj . 

1 1 \ steria. 
Epilepsy . 
Neurotii 
Genius. 
Idiocy. 



Sensory I Deaf Mutism. 

Degeneracy ' Congenital Blindness. 

Lymphoid Degeneracy. 

Tissue [nstability. 
Nutritive Plural Births. 

Degeneracy Bleeders. 

Excessn e Fecundity. 

Gout. 



Spinal ^ Various Congenital and Hereditary Disorders. 

Jaws. 

Cleft Palate. 

Teeth. 

Primitive Uteri, 

( !loaca) Conditions, I 
Local Elorse-shoe Kidney, and Allied States. 

Reversional Qyclopian Monstrositi< 
Tendencies. | AmoUac an a Polymeliac States, Club Feet. etc. 

Plural Mammae. 

Simian Muscular and Pony States. 

Liver, and other Organ Reversion. 



• and Allied Male Stat. 



118 ETIOLOGY OF OSSEOUS DEFORMITIES 

As a result of defective cerebral and spinal development, 
we have three great classes of brain degeneracies — ethical, 
intellectual and sensory — resulting from defective nutritive 
and local deformities. 

Among the local manifestations which seem most apt to 
appear as stigmata, owing to the great tendency of variation in 
structure of the body, in evolution, are those in the cranium, 
nose, face, jaws and teeth. The author does not mean, how- 
ever, to infer that other parts of the osseous system or organs 
of the body are not so often affected (indeed, he is of the 
opinion that they are), but that there is no one organ or part 
of the body which is so often affected as these. Thus, as we 
shall see, taking a given disease of the brain, such as para- 
noia, epilepsy, etc., from seventy to ninety per cent will 
possess deformities of the cranium, face, jaws and teeth; but 
it would not be possible in a given disease to find seventy to 
ninety per cent of primitive uteri, horse-shoe kidneys, or 
liver reversion. We shall, however, in almost every case, 
where the jaws are deformed, find some one or more of the 
conditions of the organs or tissues of the body named under 
the head of local reversion. We shall also be able to find the 
missing link which seems to unite our every-day patients 
with those confined in our public and private asylums. In 
order to accomplish this we have only to study those con- 
ditions which come under the head of cerebral reversions, 
resulting in deformities of the cranium, nose, face, jaws and 
teeth. We shall, therefore, take up each subject in the order in 
which they appear in the table, and see what relation they bear 
to each other and to deformities of the osseous system (the part 
of the body in which we are most interested). It will be well, 
however, before doing so, to give the reader an idea of what 
we expect to find beforehand, so that he will be able to 
follow each case, and thereby comprehend the results as the 
brain presides over it. If the brain is deformed we expect to 
show that one of two conditions must naturally folloAv — 
excess or arrest of development — or physiological hyper- 
trophy and atrophy, and not pathological hypertrophy and 
atrophy, as the terms are usually used. We also expect to 
find degeneracy of the soft tissues as well.. 



CHAPTER X. 

CRIME. 

irding to L >mbi — . crime, <u- its equivalent, is found 
among the lower animals and some few plants as w « * 1 1 as 
in man, *>u t in man it assumes a more serious nature, 
from the fact that man is able to discriminate between 
right and wrong. This discrimination, however, is also 
found among Borne of the higher animals, but it is of such a 
modified type that most thinkers are inclined to call it 
instinct. There arc only a few species <>t' what might be 
called criminal plants, the most common being the fly-trap, 
found in Southern United States. Should a fly, or other 
insect, happen to settle upon one of its leaves, it is certain 
death to the insect, for no sooner than it alights, the leaves 
close, holding the creature firmly until its small life has 
ended. 

Crime in animals, however, has more of the conditions of 
man. In the animal, we find conceit, theft, swindling, lazi- 
ness, and even premeditated crime. The habits of the dog 
and cat for theft and slyness are common to all; generally, 
the theft is to appease hunger, and not confined to useless 
articles so characteristic of the thefts of magpies, crows, rats 
and monkeys. This latter is allied to the clement of klepto 
mania so common in man. 

Animal- arc conscious of their own deceit, a- shown by 
the fact that they operate secretly and with precautions t<> 
avoid discovery. Thus we know thai savage animals approach 
their prey a- noiselessly a- possible, and if discovered before 
springing steal away and lie in wait for a better opportunity. 

Among some of the African tribes and those people 
inhabiting the Eastern Archipelago, crime i- the rule — in 
fact, in some part- of Borneo a young man cannot marry 
unless lie has killed at least one man. The ancient Greeks 
sought to calm the wind- by human sacrifices, and mythol- 
ogy tells us that crime was triumphant in heaven. By the 

119 



120 ETIOLOGY OF 08SEOU8 DEFORMITIES OF 

laws of the middle ages, theft by a common man was consid- 
ered much worse than if committed by a chief; but through 
the increase of invasions and despotism, thefts by chiefs 
became a greater crime than assassination. The chiefs, how- 
ever, who were both judges and executive magistrates, sought 
to maintain laws which would be advantageous to themselves, 
and it may be that through this selfishness morality pene- 
trated society. 

The germs of crime are met with in infancy. It is no 
uncommon thing for a child to strike at its parents or nurse 
at the age of one year, and frequently in a fit of anger to snatch 
at or break small articles near it. This is crime in an embry- 
onic state. Mendacity in children usually arises from the 
ways in which their parents deceive them to render them 
quiet. 

Cruelty among children is found in all classes and nations, 
and especially among boys; they take delight in breaking 
articles, or killing small animals, insects and worms; indeed" 
there seems to be an element of destructiveness in their 
nature, which is only overcome by a strict moral training. 

McDonald says: "Murder, no less than anger, vengeance 
and cruelty, is found in children. Caligula, at 13, had a 
slave cast into an oven for a slight offense. Two children, 
the one 13. and the other 10 years of age. having a spite 
against a comrade of 7 years, met him in an out-of-the-way 
place, threw him into a deep hole, and stoned him to death. 
A boy in the state of Iowa (11 years of age) went early in 
the morning into the room where his grandparents were 
sleeping, and shot them both; seeing his grandfather move, 
he finished him with an ax. He told the boys afterward: 'I 
did it all alone.* The occasion of his deed seems to have 
been a refusal to allow him to do something. Another boy 
of 13 stabbed his comrade in the heart because he refused to 
pay a debt he owed him for a game. Such crimes in the case 
of children, if less cruel than in the case of adults, are so 
from the lack of force rather than ferocity." This is also 
nicely illustrated in the familiar circumstance of the epileptic 
Pomeroy, of Boston, who was in the habit .of spending his 



I ill HEAD, FACE, JAWS AND TEETH 121 

leisure moments amusing himself '»\ sticking his knife into 
bifl plaj mates, and finallj enticed one of hi- comrades into i 
belfry and killed him in the same manner. 

From a sociological standpoint, war is but universal mnr 
der, and in primitive times it- terrible character even Bur- 
passed the ferocitj of wild beasts. In these early tim<-- th<- 
t*i uiii \ was mutilated and tortured, but modern war has done 
away with torture, and :it the present time inventive genius 
is striving its utmost to discover how to kill and disable the 
enemj .-it great distances, and in this achievement they have 
almost, if not quite, succeeded, much to the disgrace of the 
enlightened nineteenth century. We look upon the cannibal 
with horror, yet the words of Montaigne come most vividly 
back to us: "'It is more barbarous to kill a live man than to 
roast and rat a dead one.' 1 

A minute and careful analysis has been made of the his- 
tory of each individual hereafter cited, to show the different 
crimes under which each person was sentenced, and also to 
-how that no two are exactly alike. It has also been shown 
that the deformities of the osseous system (excess and arrest 
of development) are unusually common and differ in each 
individual. This collection of skulls of criminal- and degen 
crate- is certainly the most interesting that can be found in 
this country, and the author was very fortunate to be able to 
secure them for the purpose of obtaining these illustrations. 
It would not be possible to obtain skulls of as many degener- 
ates of any other class, but the author is free to assert that 
as marked deformities can be found among the other clas 
of degenerates 

"Lombroso, Ferri and Manouvrier claim certain peculiari- 
of development in the criminal jaw. Exaggerated devel- 
opment of the zygoma? and lower jaw is the especial feature 
commented upon by Lombroso. Ferri has found the greatest 
diameter of the jaws among homicides and petty criminals; 
the smallest among professional murderer- and pickpocket-. 



* The following on the subject of Crime, is from a joint paper i 
of Criminals." by G. Frank Lydstoo ami fche author, taken from the .4' 
and .V- . St. Louis, I L881 . 



122 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

The jaws, according to Ferri, are not well developed among 
the insane, save those who are the subjects of impulsive 
monomania. This does not agree with Dr. Talbot's observa- 
tions. 

In our studies of criminals we have found that the most 
marked variations from the average normal type of cranial 
development occur among the habituals. We have made no 
attempt to select special cases bearing out this assertion, but 
have studied each case as it has been taken at random. We 
append a series of observations upon criminals, selected by a 
convict orderly froih among the habituals and murderers in 
the Joliet penitentiary. In reply to his inquiry as to what 
kind of cases we wished to study, we remarked that we 
wished to see old-timers or habituals. He therefore selected 
the prisoners according to their criminal, with an entire dis- 
regard to their physical status, with the possible exception 
of several who happened to be on sick call. All complaints 
of subjective ailments were verified by the resident medical 
officers. 

I present the history and description of several of these, 
selected from the original paper. 

Obs. I. — White, male, American, aged thirty years. Has 
been committed twice for burglary. Was first committed at 
the age of twenty-two, since which time has been a con- 
firmed criminal. Hereditary influences as a possible cause of 
delinquency not probable. Intemperance is admitted, and is 
claimed to have had much to do with his moral degradation, 
and as he is markedly neurotic this is highly probable. 
Syphilis is denied. Never experienced an injury until two 
years ago, when he received a severe fall, with contusion of 
of the head. This was followed by epilepsy, severe head- 
aches, insomnia, deafness, defective vision in the right eve 
and pronounced right hemiplegia. Hearing normal. Mentality 
impaired. He is thin, anaemic and badly nourished. Was 
formerly right-handed, but has acquired left-handedness since 
the accident. The jaws, especially the inferior, are quite asym- 
metrical and the nose deflected, not from traumatism. Features 
very asymmetrical. Ears small, protuberant, pointed and 



i ill HEAD, FACE, JAWS AND TEETH 128 

asymmetrical, tin* left being the larger and more prominent 
The Beptum nasi is thickened and greatly deflected. < ran mm 
of medium development, of sob brachj cephalic type and rafter 
Bhaped calvarium. Jaw, orthognathous. Occipital region 
\n\ prominent and asymmetrical, the protuberance J > « • i 1 1 «_r 
markedly deviated to the left of the median line. Pro 
nounced asymmetry of parietal development, the left emi 
nence being rerj prominent and t h«* right perceptibly flat 
tened. Palate imperfectly developed with a V Bhaped arch. 
Obs. II. White, male, [rish, aged twenty-seven years. 
Sentenced for arson. Committed for the second time, the 
first offense being robberv. Has led a criminal Life since 
childhood, being addicted to petty and minor delinquencies 
for which he escaped punishment. Know- nothing of his 
parentage or family. Has never been addicted to drink. 
Admit- Byphilis. [a thin, anaemic and poorly nourished; 
Bays that he was never very Btrong. Right handed. \ .. 
lameness or deformity. Slightly deaf . Vision normal. Per 
ceptive faculties somewhat blunted and mental processes 
sluggish. I> a meiancholiac, and sutlers from severe head- 
aches. Feature- noticeably asymmetrical. Nose percepti 
l>ly deflected and flattened, not traumatically. Septum thick, 
crumpled and on the right side enchondromatous, the right 
nostril being occluded. The ears are peculiarly deformed, 
the right being small, thick and crumpled, the left of medium 
size and very protuberant, handle-shaped. Cranium large, 

ultra-brachycephalic, with platycephalic vertical index, and 
resembling in its general outline the skull shown in Fig. 33. 
To the left of the vertex the calvarium is flattened, but the 
left parietal protuberance is very prominent, the entire left 
side bulging in outline. The right Bide is flattened and the 
parietal prominence slightly marked. The body of the 
occipital hone is very Btraight and flat, but the protuberance 
is disproportionately prominent. The facial outline is orthog- 
nathous, the jaw being of a pronounced retreating type and 
very asymmetrical. Palatal arch V-shaped. 

( >BS.II1. — White, male. American, age I forty year-. Sen 
ing second sentence for burglary. Prior to first c unmitment 



1^4 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

had been sentenced for numerous petty delinquencies, and 
had been tried on charges of burglary and acquitted on sev- 
eral occasions. History shows a bad heredity. Mother 
healthy, but father died of consumption, and a sister is sub- 
ject to fits. Has been addicted to liquor. Says that liquor 
is responsible for his life of criminality (?). Contracted 
syphilis eighteen years ago. which has troubled him off and 
on ever since. General appearance very fair, is well nour- 
ished and of good color. Right-handed. No lameness or 
deformity, but plentifully supplied with syphilitic scars. Is 
quite deaf, and vision is so defective that he reads with diffi- 
culty. Suffers from tinnitus aurium. The facial contour of 
this man is very striking. There is such a marked disparity 
and asymmetry of the two sides of the face that it has the 
appearance of two halves of faces of different sizes joined 
together and by a bad artisan. Nose deflected markedly and 
septum twisted and malformed so that the left nostril is com- 
pletely blocked. The ears are very asymmetrical and situ- 
ated on different planes, the right ear being much the 
smaller and situated several lines higher than the left. 
Cranium sub-microcephalic and very asymmetrical. The 
right side of the cranium is very perceptibly flattened and the 
parietal prominence feebly marked. The left prominence is 
very marked. The forehead is low and retreating. The 
narrow and contracted skull in this case is directly noticea- 
ble, but the index is sub-brachycephalic on account of the 
markedly sloping frontal region, which compensates in a 
measure for the narrow transverse diameter. The facial 
type is orthognathous. On examining the mouth, a high 
palatal vault of partial Y-shape, with pronounced saddle 
contour on the right and full curve on the left, are noted. 
There is marked faucial and pharyngeal asymmetry. 
There is a lateral curvature, which accounts, in a measure, 
for the pharyngeal and faucial deformity. An interesting 
feature of this case is that the subject suffered from 
constant and severe headaches until fifteen years of 
age. They then stopped, but were developed later in life 
by liquor. Has had them steadily for the last fifteen months. 



i n I II I \l ». FACE, FAWfl w i i I i i l II 

and is Buffering from insomnia possible pachymcning 
syphilitica or alcoholics suggests itself in this connection. 

Obs. IV. White, male, German extraction, age fort} -one 
years. Serving time for murder. This case is most interest 
in- as .-in example of illogical dispensation oi 1 .1 w and of the 
physical basis of crime. The Btibjeot is typicallj neurotic; 
heredity bad, mother having died of cancer and her branch of 
the family being subject to various forms of nervous disease. 
Cause of father's death unknown, but lie was known to have 
been a dissolute character. The subject under consideration 
was struck in the head with a hatchet when r child. Since 
the age of eight he has had epilepsy, the tit- occurring 
sometimes everj three or tour days and at others at very long 
intervals. Has at times escaped them almost entirely for a 
year or two v and has then brought them on by indulgence in 
liquor, to which he wasaddicted; subject to violent paroxysms 
of fury at all times under slight provocation; has been com- 
mitted to the asylum Beveral times; history would seem to 
point to the furor epileptious as a cause for the murder which 
this man committed. The noteworthy fact is that this man 
is \ ery artistic and spends much of his time in making artificial 
(lowers. Syphilis Is denied, and no evidences of the disease are 
perceptible; subject is pale and anaemic; is right-handed; vision 
normal, but is quite deaf in left car: no deformity or lame- 
ness. Features very asymmetrical, the right Bide of the face 
being much larger than the left. The nose is markedly 
deflected to the left, the septum being thickened, crumpled 
and deviated inthe -Mine direction. Ears verj asymmetrical, 
the left being the larger, higher situated and badly formed. 
The right ear is Very protuberant, imperfectly developed 
and crumpled. Cranium of medium size, quite round and 
dome-shaped. Vertical index oxycephalic. Index markedly 
brachycephalic. The skull -how- the same asymmetry as the 
face, the right side being disproportionally developed and the 
right parietal eminence very large. The left Bide is flattened 
and the parietal prominence barely distinguishable. The arch 
of the jaw in this case is normal, but the development of the 
palate is defective and the rami defective in development 



126 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

Obs. V. — White, male, American, aged thirty-seven years. 
Committed for the third time for burglary. Family history 
unknown save as regards mother, who died of cancer. Has 
had syphilis, and has been intemperate since youth. Was 
hurt in a railroad accident in 1881. Prior to this time he 
had worked tolerably steadily, but since the accident he had 
drank harder than ever and had developed an uneasy, rest- 
less disposition, which made honest labor irksome and crim- 
inality attractive. General appearance fair, is well nour- 
ished. Right-handed and has no lameness or deformity. Com- 
plains of tinnitus in the right ear, referable he thinks to the 
railroad accident. Vision and hearing normal. Face very 
asymmetrical, the right side being much the larger. Right 
malar prominence exceptionally marked. Left eye so dis- 
proportionally small as to attract the attention of the casual 
observer. Nose deformed and septum deviated to the left, 
but as the organ has been broken this point is not of great 
importance. Ears very small, crumpled and closely set, 
the left being much the larger and lower. The skull 
is submicrocephalic in capacity, oxycephalic in its ver- 
tical and brachycephalic in its cranial index. The right 
half of the cranium is the smaller, with the exception of 
right occipital and mastoid regions, which are excessively 
developed. The left parietal eminence is very prominent. 
None of the aberrations noted were referable to the injury, 
except possibly the nasal deformity. The superior maxilla 
is V-shaped. 

Obs. VI. — White, male, Irish, aged fifty years. Serving a 
five^ear sentence for horse stealing. Served a six-year 
sentence twenty years ago for the same offense. Acknowl- 
edges repeated offenses for which he has never been punished. 
Family history not clear, but says that father died of old 
age and mother of "fever sore " on her leg; has been intem- 
perate since youth, and has had severe syphilis; has had 
severe small-pox, with resulting great disfigurement, not 
shown in cut; general appearance fairly healthy; is very 
awkwardly built, " shtb-sided " as the orderly expressed it; 
his gait is of the shuffling or shambling variety; is right- 



I \< I 



\M» I I I I II 






banded; is lame as h consequence of syphilis; bearing nor 
himI; vision bas been impaired for man} {rears; features 
\«i\ asymmetrical; the face \t long and narrow and 
the ohin pointed, but nol prognathous; the left eye much 
smaller than the right, not properly shown in cut, and th*e 
entire left Bide of the face imperfectly developed; the nose is 
slightly flattened and the septum deviated to the left, the 

nostril being nearlj occluded; the ears are asyi otricaUj 

developed, the left being the larger, most thickened, irregu 
lar and deformed; cranial index brachy cephalic; vertical 
index platycephalic; the large size and disproportionate 




%: 



Pig. 28. 

breadth of the cranium arc very noticeable. The cranium is 
asymmetrically developed. The right frontal eminence is 
very prominent The left parietal prominence is verj large. 
The calvarium is depressed .-it the right of the vertex. There 
is also a well-defined depression at the bregma. The right 
occipito-mastoid region is excessively developed (Fig. 28). 
The generally twisted appearance of cranium already alluded 
to is well shown in this subject. The jaws are saddle 
shaped, and the palate ii regular and unevenly developed. 
The action- and garrulous conversation of this subject 
showed him to be a paranoiac of a pronounced type. A 



128 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



glance at the physiognomy of this man, as shown in Fig. 29, 
is suggestive to the neurologist in this connection. A 
marked sunken condition is noticed under the eyes, extend- 
ing down to the lower jaw, showing arrest of development of 
the hones of the face. 

Obs. VII. — White, male, American, aged fifty-three year-. 
Sentenced for horse stealing. Had several sentences elsewhere, 
and is serving a second term in Joliet. Family history not 
obtainable; had been occupied in farming and horse dealing, 
alternating with horse stealing most of his life: no history of 
syphilis or alcoholism; general appearance bad, pallor and 




Fig. 29. 

cachexia being pronounced; is right-handed: presents no 
lameness or deformity; vision and hearing normal; the feat- 
ures are very asymmetrical: the nose is quite straight, but 
the septum is deviated to the left, producing partial occlu- 
sion; the eyes are small, deep-set and somewhat of the 
slanting type peculiar to the Mongolian. This peculiar slant 
is most evident upon the right side; the right eye is also 
smaller and on a higher plane than the left. The difference 
in development of the two sides of the face is very marked, 
the right being the smaller. The left half of the inferior 
maxilla is much longer and straighter than the right. Hair 



I 111 



III \l». I \« I . JAWS \M - I I I I II 



120 



baa been verj Rraj since quite a young man. The right 
i- of moderate fair form and \<t\ closelj set; the 

left i- flattened, flabby and protuberant, " handle-shaped " 
and lower than the right. Cranial capacity ia meaooephalic 
and oranial index sub-brachycephalic. The vertex ia pointed, 
oxycephalic, with marked depression upon each Bide of the 
median line. The lett occipito-mastoid region ia exceed 
prominent, the right being deficiently developed. The left 
parietal eminence ia very prominent and tin- right poorly 
marked. Semi-V-shaped superior maxilla; lower maxilla well 
developed. Thia subject is an apt illustration of the irony of 




Pig. 30. 

fate and the unintelligent administration of law. He ia a 
paranoiac ami affected with monomania of the religious delu- 
sional type At times imagines himself Jesus Christ. II« 
preaches in his cell to imaginary spirits, over which he imagines 
that he ha- control, ami regales hi- fellow-convict- with an 
occasional sermon on their wicked way-. Hi- conversation is 
characterize*! by egotistical garrulity; is particularly desirous 
of impressing us with the idea that hi- magnificent head was 
designed for souie great purpose which "died a-bornin'." 
Like the preceding ease, the physiognomy of this subject 
(Fig. 30) is to the alienist confirmatory of the foregoing 



130 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

remarks. Here is also noticed arrest of development of the 
face at the alae of the nose — showing the prominent cheek 
bone and lower jaw of Lombroso. Right eye much higher 
than left. 

Obs. VIII. — White, male, Swede, aged thirty years. Up 
for larceny, second conviction, and acknowledges offenses for 
which he was never punished; has worked at different trades 
and occupations, but labored steadily until he received the 
injury herewith described. Family history obscure; mother 
had some skin disease of a severe type; has been a moderate 
drinker; syphilis is denied; general condition fair; is some- 
what anaemic; is right-handed; some years ago was caught in 
a railroad smash-up and sustained a fracture of the skull; 
several years ago had his arm caught in machinery and 
received a compound fracture of the forearm; was in hospi- 
tal seven months. Hearing greatly impaired; vision normal. 
The face is very asymmetrical, the right side being the bet- 
ter developed, and the right half of the jaw especially promi- 
nent; nose of normal type; no deflection of septum; ears very 
asymmetrical, the left being the larger and more closely set 
and decidedly pointed; the right is of medium size and nor- 
mal outline, but situated lower than the left; jaws square 
and well formed, but the hard palate is very asymmetrical; 
left palatal process much broader than the right. The 
cranium is large, horizontal index brachy cephalic; vertical 
index platycephalic; the frontal region is asymmetrical, the 
right prominence bulging decidedly; the parietal prominences 
are exceptionally well marked, the left being much the 
larger; the entire right half of the cranium is disproportion- 
ately well developed, with the exception of the parietal emi- 
nence; depression at site of old injury in parietal region. 
This subject, like the foregoing, should not be in prison. He 
is a paranoiac — has delusions of persecution, quarrels with 
imaginary enemies in his cell, and has on one occasion 
attempted suicide by cutting his throat. 

Obs. IX. — White, male, American, aged fifty-nine years. 
Fourth commitment; offense, horse stealing; committed three 
times before on u general principles:'* does not deny that 



I III III \l\ PACK, JAWH \M» I I I I II 



181 



said commitments were for the public good; heredity bad; 
father died of cancer of the atomaoh, mother was insane and 
died oi oomsumption; Bays he does do! give a - 1 ".- 1 U . hi- 
tor\ for the purpoae oi exciting -\mpath\ says his motto 
[a: "Sympathy be d &\ n He haa never been intemperate; 
says thai be feared to drink on account of the Insanity in bis 
blood; Byphilia ia denied; had bis bead cut by a rock in 
Chester penitentiary yeara ago. Genera] appearance quite 
bad; ia anaemic and poorly nourished; waa originally right 
handed, but on account oi lameness in joints oi right 
hand baa acquired the use of left; left arm ia also lame 
from injury; joints arc generally crippled by arthritis 
deformans; vision presbyopic; hearing normal. The face ia 
very asymmetrical, the right Bide being the larger; oose 
malformed and deflected to the right; septum deflected and 
presents a large perforation; ear- oi average development 
and Bymmetry; right ear a little lower than left; dental 
arches normal but inferior maxilla greatly flattened at 
angles and quite asymmetrical; cranium of average develop- 
ment; Bub-brachycephalic index. Since the injury to his 
head this man Btatea that he has "wild spells" when his 
mind ia aberrated. These "spells" follow severe headache-. 
This man. although uneducated, is quite talented, very bright 
and Logically argumentative. Bis moral obliquity is evi- 
dently due to a bad heredity and lack of mental discipline. 
Under more favorable auspice- he would have made a valua- 
ble member oi society. Arrest oi hone- oi the face. 

OB8. X. -White, male. German, age thirty-one year-. 
Serving sentence for grand larceny. Has been in prison rive 
times, this being his third term in Joliet. Heredity had; father 
healthy but intemperate, quarrelsome and BUDJect to violent 
tit- oi passion, which made him a "dangerous customer" at 
times; an only brother, though honest, is intemperate and 
a ne'er-do-well: paternal grandfather -aid to have hern a 
martyr to scrofula. Has not been intemperate: syphilis denied. 
but states that he wa- very scrofulous a- a child: extensive 
scrofulitie scars visible on neck and face; is -till quite sickly, 
looks cachectic and badly nourished: i- right-handed: no 



132 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

lameness or deformity; vision and hearing normal; facial 
asymmetry quite marked, the right side being much the 
larger. The nose is markedly deviated to the left and the 
septum much deformed and deviated to the right, producing 
almost complete occlusion. The left palpebral fissure much 
smaller than right; left eye perceptibly smaller than right; 
ears fairly symmetrical and well formed; cranium very large, 
index ultra-brachycephalic, vertical index platycephalic; fair 
degree of symmetry; left parietal eminence very promi- 
nent. This subject has been affected with severe stammering 
since childhood; is frequently under treatment for severe 
cephalalgia, and has had since childhood what he terms 
"dumb spells," which we interpret as mental depression, 
probably associated with disturbed circulation. The inferior 
maxilla in this case was poorly developed, orthognathous and 
very pointed; upper jaw presents a marked saddle-shaped 
arch. Arrest of bones of the face. 

Obs. XL — White, male, Swede, aged twenty-seven years. 
Acknowledges habitual criminality, though serving first sen- 
tence; is in for highway robbery; heredity not shown; mother 
died of dropsy and father of pneumonia; intemperance and 
syphilis both admitted; no history of injury; general appear- 
ance fair; right-handed; somewhat lame in left leg (thinks 
that he always was weak in this limb); vision and hearing nor- 
mal; face asymmetrical, leftside much the larger — leftside 
of the lower jaw being extraordinarily prominent; left pal- 
pebral fissure and eyeball much smaller than the right; nose 
deflected to the right, with marked corresponding deviation 
of septum; ears very large, long, pointed and closely set; 
cranium sub-microcephalic, with sub-brachycephalic index; 
oxycephalic vertical index. Development of average sym- 
metry. In his general characteristics this subject is a weak- 
ling, and the crime for which he is doing time is inconsistent 
with his physique. The jaws in this case are markedly 
deformed, the upper presenting a semi-V and the lower a 
marked saddle, with arrest of bones of the face. 

Obs. XII. — White, male, half-breed Egyptian, age thirty- 
five years. Serving sentence for horse stealing. Says that it is 



I I! i HEAD, FACE, JAWS AND TEKTI I 1 00 

his first commitment, but his statements are oonl radictorj . and 
he has either been committed before <>r has led a criminal life 
without punishment; the t'amik history Is imperfect, as he 
w .i- bom in Eg} pi of a native mother and an American father. 
One brother is known to be insane i>m not criminal; has 
drank periodically after he has hadone of tin- "fits," to be 
described; syphilis denied; when quite a young man he 
enlisted in the American navy and Berved for some years; 
was finally discharged for disability, having been sunstruck 
while in the foretop, falling to the deck and sustaining s< 
head injuries, the scars of which -till remain. After his die 
charge he Buffered from epileptic tit- at interval- of from a 
few days to a tew weeks; is -till suffering from these attacks 
and from severe headache-: criminal career began since 
in j 1 1 r \ :. General appearance excellent: right-handed; no 
lameness or deformity: head badly scarred from old wound-: 
vision and hearing normal: face fairly symmetrical; i 
equally developed; right side of face slightly the larger; 
nose not deformed, but septum deviated to the right, with 
partial occlusion of nostril; ears very small, closely Bet and 
crumpled. Cranium large and index sub-brachycephalic; 
development asymmetrical; right Bide much the larger; 
occiput unequally developed, right half being very prominent : 
left parietal eminence very large as compared with theright; 
jaw- normal. Degeneracy of physical type i- not very pro- 
nounced in this subject. We consider the history of injury 
a very important point. 

0B8. XIII. — White, male. American, aged twenty--ix 
\ ear-. ( 'onimitted for the first time for forgery; acknowledges 
petty delinquencies before sentence for forgery; family his- 
tory had: father delicate. BCrofuloUS and affected all hi- life 

■ 

with sore eye-: mother died ^i consumption; has been a 
steady but moderate drinker : Byphilis denied : general 
appearance good; right-handed; vision and hearing normal: 
face quite asymmetrical, left half much the Larger; left eye 

much smaller than right; nose straight and symmetrical, but 
septum markedly deformed: ear- symmetrical, but very 
small and closely set; cranium of medium size and asymmet- 



134 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

rical; index mesocephalic; left occipitoparietal region dis- 
proportionately developed; right half of occiput flattened; 
protuberance situated seven mm. to the left of the median 
line; left parietal eminence very prominent; facial develop- 
ment marked; pronounced prognathism of inferior maxilla. 

Obs. XIV. — White, male, Irish (typical imported crimi- 
nal), aged fifty-four } r ears. In for bank robbery on long sen- 
tence. This is one of the toughest specimens that ever broke 
into jail; he has done time in a number of prisons in Amer- 
ica, and served several sentences in England before being 
exported to this country by the generous British authorities; 
family history bad; father intemperate; both parents died of 
consumption while subject was very young; one brother died 
of consumption; has always been a hard drinker; has had 
syphilis; general appearance very bad; is thin, sallow and 
badly nourished; has a chronic cough; is somewhat crippled 
by rheumatism, otherwise no lameness or deformity; hearing 
normal; vision impaired by age; face very asymmetrical, 
left side being disproportionately developed; left eye per- 
ceptibly the larger; right frontal prominence, however, is 
bulging and prominent; nose badly deformed; septum enchon- 
dromatous and deflected, and so badly deformed that it is 
visible externally; ears very prominent and pointed; the left 
is badly crumpled; cranium sub-microcephalic; index sub- 
dolichocephalic; fairly uniform development on each side, 
but right side much the larger; lower jaw small, prognathous 
and left half much the larger; upper jaw large, with low 
arch. 

Obs. XV. — White, male, Dane, aged forty-two years. 
Serving life sentence for murder; family history good; has 
never been intemperate, and, until the commission of the 
crime for which he is under sentence, he was an honest, hard- 
working farmer, distinguished only by a violent temper; the 
murder for which he is doing time was the result of a quar- 
rel; has never had syphilis; general appearance excellent; 
right-handed; vision and hearing normal; no lameness or 
deformity, features asymmetrical, the preponderance of 
development being on the left side; nose deformed and 



l ill HEAD, FACE, JAWS \M» I i i I ii 

deflected to the right; septum shows a corresponding deflec 
tion; ears asymmetrical, the right being pointed, closelj 
and of medium Bize, the lefl large, protuberant and l< 
Bet than the right; cranial capacity mesocephalic; index 
sub-brachy cephalic; pronounced asymmetry, the left side 
being the larger, the development of the left occipito parietal 
region being especially disproportionate; the right pai i 
eminence is much larger than the left; the forehead is low 
and retreating; frontal prominence slightl} marked on left 
Bide, and absent on right; upper ja^i excessively developed 
and prominent: arch Bemi- V-shaped; lower jaw prognathous 
and heavy, and disproportionately developed on the left 
side. 

Ob8. XVI. White, male. American, aged forty-two 
years. Serving a life sentence for a murder which had been 
committed in a quarrel. Prior to this crime had been an 
industrious farmer. Family history unknown; alcoholism 
and Byphilis denied: general appearance fair; right-handed; 
no lameness or deformity; is lame at time- from rheumatism; 
vision impaired; hearing normal; nose well shaped; no 
deflection of septum; ears -mall, thin and closely se t; era 
nium above the average capacity and fairly symmetrical; 
index brachy cephalic; some flattening at the bregma and in 

the occipital region; Upper jaw excessively developed and 
partial Y-shape; lower jaw massive and prognathous. 

<)r,-. XVII. — White, male, aged seventeen years. This is 
one of the most melancholy cases which have come under our 
observation -the prisoner, a bright, handsome hoy. having 
been sentenced for life for a murder committed while under 
the influence of liquor. The lad was raised on a farm and his 
family history is unexceptionable. Habitual intemperance 
denied; no history ^f syphilis; genera] appearance excellent, 
hut subject is plainly neurotic; is right-handed; no lameness 
or deformity; vision and hearing normal; facial development 
quite symmetrical, save a little excess of development of the 
right half of the inferior maxilla; nose slightly deviated, with 
some deflection of septum; ears large and protuberant (oreilles 
ti cm$e)\ capacity of cranium mesocephalic. Practically no 



130 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

asymmetry, the form of the cranium being better than the 
average normal type. The lower jaw is asymmetrical, as 
above noted, and the upper jaw presents a partial V, with 
arrest of the facial bones. 

Obs. XVIII. White, male. American, aged sixty-one 
years. Doing: time on fourth commitment. Last offense burg- 
lary and arson. Family history unknown. Was evidently 
a vagabond in early life, but was never convicted of crime, and 
he states was never delinquent until 1871, since which time 
he has been in jail off and on— in fact, for the greater part of 
the time. Intemperance and syphilis is denied. Drifted into 
the army in his early manhood and was several times wounded. 
Is lame from a saber cut in the left leg, and head shows a 
large scar from a saber cut received in '63. General appear- 
ance excellent: vision and hearing normal; right-handed; has 
been gray for many years: face fairly symmetrical; nose 
slightly deflected, but septum well formed; ears well formed; 
cranial capacity mesocephalic; index brachy cephalic; asym- 
metry not very pronounced; left parietal eminence dispropor- 
tionately prominent; occipital region exceptionally flat; mas- 
toid prominences excessively developed; normal arch in upper 
jaw; lower jaw very prominent, heavy and prognathous. 

The foregoing cases might be multiplied from the material 
at our command, but they are amply sufficient as indicative 
of what may be found among the degenerate classes met with 
in our American prisons. A glance at these cases plainly 
shows the physical degeneracy and often the bad heredity of 
the subjects. A noteworthy fact is that the cases which most 
nearly approximated the normal type of development were 
in sporadic criminals, of which the young lad (Obs. XVII.) 
is an example. It will be noted that a number of the series 
were of foreign birth. As before remarked, it will be found 
that the most markedly aberrant types are seen in the imported 
criminal. This is instructive as explanatory of some of the 
apparently dogmatic claims of European criminal anthropol- 
ogists. We have found that left-handedness is not so com- 
mon among American and foreign-American criminals as has 
been claimed bv these authorities. Anion* -100 criminals in 



Mil DIM 



.1 \\\ - \\l» I I I I II 






the Joiiet penitentiary but one per cent were found to be 
left handed. Dr. Lydston found but about two per oent 
amen- the criminals in the Ne* 5Tork I Jit} prison. ( foviously 
a ninth larger number of observations would be necessar} to 
determine this point 

It Is our fortune to be able to present in this work a 
Beries of illustrations of specimens Bhowing the aberrant 
types and asymmetry found in degenerate skulls, and espe 
oially those of oriminals. These specimens are exception- 
ally interesting from the fact that they have aot been 
selected from among a large number, but have been picked 
up here and there by non-scientists solely for their morbid and 




Fig. 31. 



historic interest, having subsequently fallen into 1 >r. Lydston's 
hands quite by accident. It is worthy of comment that even 
the remarkable series depicted in Lombroso's "Atlas" 
not present such markedly aberrant types as this compara- 
tively Bmall series of studies; indeed, a search among several 
thousand skulls would not he apt to bring to light such pecu- 
liar types of conformation as the crania which we present. 
The illustrations are from photographs, and arc- exceptionally 
accurate. 

The specimen tirst to be described I Pig. 31 1 is one of the 
most interesting crania which we have had the privilege of 



138 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

studying. The subject was a negro criminal of the petty 
class, who .spent most of his time in correctionary institu- 
tions. As might be inferred from the extremely degenerate 
type of cranial development, which is here exhibited, he was 
of a very low grade of intelligence. After a very precarious 
existence this negro committed suicide. 

In viewing this skull from the front, one is at once struck 
by the immensely powerful maxillary and malar develop- 
ment as contrasted with the remainder of the cranium. The 
orbits are relatively very capacious. The superior maxilla is 
relatively poorly developed, at least as compared with the 
lower jaw. Rarely, indeed, is such an inferior frontal devel- 




Fig. 32. 

opment found associated with such a pronounced facial 
development. 

As will be seen in connection with the specimen of brachy- 
cephalic 'degeneracy, shown in Figs. 48 and 49, the frontal 
development in this narrow type of skull may be vastly bet- 
ter than some specimens with a decided tendency to the 
brachycephalic type. The skull at present under consider- 
ation is the most marked specimen of the dolichocephalic 
cranium which we have seen. As the horizontal index in 
this case is 59.9, the extreme variation, according to Isaac 
Taylor, and others, being from 5S to 98, the extreme type of 
this skull is at once obvious. 



i in READ, ] M Bj JAWS AND TEETH 

( )n \ ievi ing this Bkull laterally 
llarity to the anthropoids is verj striking. Thie ally 

marked with respect to the development of the mastoids and 
the occipital protuberance; the position of the latter is <piit<- 
an anomalous one, and the occipital bone is almost horizontal. 
Despite its extraordinary development, the occipital is rela 
tiveh hi Kill, both transversely and in its vertical measurement. 
The distance from the posterior border of the foramen mag 
num to ilif superior occipital angle is only L03 mm. 

( )n contrasting with any of the other crania of the series, 
the relative shortness of the occiput is very noticeable. For 
example, Fig. 39, which is a rather small specimen, distin 
GTuished rather bv the Bvmmetrv than the extent of its devel 




Pig. 33 



opment, shows an occiput measuring L30 mm. from the for- 
amen magnum to the superior angle of the occipital bone. 

Big. 33 shows the inferior surface of this dolichocephalic 
specimen and brings out the massive development of the pro- 
cesses and muscular attachment- at the base of the skull. It 
is evident that the muscle- i)\' the ueck in this case were im- 
mensely powerful, a siru </>of non where the leverage for 
muscular action is so short a- in this particular occiput The 
facial type in this specimen is markedly prognathous a- regards 
both upper and lower jaw-. 

The tout > nsemhl, in this case is strongly suggestive of a 
reversion to the anthropoid type, which is often the distin- 
guishing characteristic of the degenerate Ethiopian type. 



14<> ETIOLOGY OF OSSEOUS DEFORMITIES OF 

criminal or otherwise.* The following are the measurements 
of this exceedingly interesting cranium: 

Horizontal index, - - - - 59.9 

Circumference, - - - - 48.4 c. 

Anterior demi-circumference, - - 21.3 c. 

Posterior demi-circumference, - - -26.9 c. 

Bi-zygomatic diam., - 13.3 c. 

Longitudinal diam., - 196.5 mm. 

Transverse diam., - 122 mm. 

Vertical diam. (vertex to foramen magnum), - 132 mm. 

Occipitomental diam., - - - :41.5 mm. 

Bi-frontal diam., - - - - - 95 mm. 

Bi-mastoid diam., - - - 114 mm. 

Over vertex, from ear to ear, - - - 317 mm. 
Ant. bord. foramen mag. to sup. occipital angle, 103 mm. 




The excessive development of the jaws* and alveolar pro- 
cesses in this specimen are such as are generally observed in 
the negro races, in whom the jaws are usually well developed 
and rarely deformed. The only noticeable feature of this par- 
ticular specimen is a high palatal vault. 

* Dr. Lydston has found in comparative studies of crania that the plane of 
the occipital bone is of some importance as bearing upon differentiation. In 
the anthropoids the relative shortness and horizontal direction of the occipital 
bone is very striking — especially is this true of the basilar process. In the 
degenerate types of human crania, or. at least, in the atavistic types, there 
seems to be a direct relation between the-tength and angle of the basilar pro- 
cess and intelligence. Dr. Clevenger called attention to the angle of the medulla 
as bearing upon intelligence, years ago. but Dr. Lydston's observations, 
although confirmatory of those of Clevenger. were made independently, as he 
had not had access to the work of the latter. 



I III HEAD, PACE, fAWS wi> mini 






The next ipecimi presents some extraord 

features. It ifl the skull of i celebrated negro panel worker, 
confidence-operator and desperado, who, ai the time of hie 
death, waa the consort of a notorious courtesan who flourished 
m ( Shicagi i Borne \ ears a£ 

Thia individual, after some years' dalliance with the law 
without especial harm to himself, waa finally knifed in a 
brawl. A front vie* of the cranium ahowa tin- ordinary and 
characteristic negro facial type, with the exception, perhaps, 
thai tin- bones are exceptionally massive .-in. I well developed. 
A marked difference i- noticed in tin- orbits. The riirht is 




nearly round, while the left is quite deformed at its outer 
lown- corner. Unfortunately the inferior maxilla is absent, 
a fact which we greatly deplore, a- the general cranial 
development suggests to us the probability that the missing 
pari presented some very interesting features for considera- 
tion. A lateral view of this cranium shows the ordinary 
dolichocephalic negro type. The cranial index is low. being 
72.1. A comparison with Fig. 31, however, -how- the 
extreme degeneracy of type in the latter to great advanl 

A view of thia skull (Fig. 35), after a section of the cal- 
varium has been removed, showa its most interesting feat- 
ures. Skulls of such extreme thickness, even among negi 



142 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

are rarely met with. The consistency of the bone in this 
cranium is very dense and hard, and traditionally this negro, 
while alive, was noted for his butting propensities. Violent 
contact with such a skull would be apt to damage the fist of 
a Sullivan. Indeed, it is said that this fellow rather enjoyed 
the impact of a policeman's club. 

We will state at this point that we are of the opinion 
that the massiveness of bony development in this case is not 
due to disease. The general character of the overgrowth, 
and the consistency of the bone, would seem to support this 
view. Syphilis may produce thickening of the cranial bones, 
as some of Yirchow's specimens show, but syphilitic bone 
does not present the characters and uniformity present in this 
case. 




Fig. 36. 

At the densest part of the calvarium this specimen 
measured 13 mm. in thickness, its average thickness being 
11 mm. A comparison with Fig. 38 readily shows how phe- 
nomenal the osseous development in this case is. The 
cranial measurements are : 

Horizontal index, - - - - 71.1 

Circumference, ----- 47.8 c. 
Anterior demi-circumference, - - 25.4 c. 

Posterior demi-circumference. - - - 22.1 c. 

Longitudinal diam., - 181.5 mm. 

Transverse diam.. - - - - 131 mm. 

Vertical diam. (vertex to foramen magnum), 128 mm. 

Bi-frontal diam., - 95 mm. 



I III 111' \l». I \< I . I \W n \N|, Hi | || 



I i:: 



1 L8 mm. 
L20 mm. 



Bi mastoid diam., 

matlO diam., 

Anterior border "t foramen magnum to bud. 

occipital angle, - 117 mm . 

Tin' upper jaw and alveolar process In tin- skull la irell 
developed, the only peculiarity being a low palatal vault. 

i. ;;,; and -"-7 -how the skull of a (iii.c notorious mem 
ber of the Chicago demi-monde. She was a yery tall woman 
of mixed [ndian and white blood. The cephalic index shows 
• what might he Inferred from the appearance of the cute a 
decidedly dolichocephalic type, and a peculiar outline. This 
Bpecimen is the most symmetrically developed of the series, 
with the exception of the Sioux squaw next to he described, 




and whether coincidental or not. the fact remain- that this 
subject presented a higher type of intellectuality while living 
than any of the other subjects embraced in this essay. The 
skull i-. nevertheless, of a degenerate type, as shown by it> 
extreme tenuity and its markedly dolichocephalic in. lex. The 
occipital portion, however, is excessively developed. 

I- g. 38 shows the extreme thinness ^i the calvarium, which 
was at the point of section only :i mm. in thickness. A strik- 
ing feature of tin- skull i- its freedom from prominences, it- 
surface being uniformly smooth and rounded. In this respect 
the specimen differs greatly from another cranium of a pros- 
titute in the same series which we have examined, hut of which, 
unfortunately, we have no illustrations. In this case there 



144 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



was an excessive development of the occipital bone, the 
enlargement being symmetrical and most marked upon the 
left of the median line. The right parietal eminence was 
excessively and disproportionately developed. The cranial 
index was markedly dolichocephalic. 

The principal measurements of the skull at present under 
consideration are: 

Horizontal index, - - - - 67.09 

Circumference, - - - 51.2 c. 

Anterior demi-circumference, - - -22.9 c. 

Posterior demi-circumference, - - 27.3 c. 

Longitudinal diam., - - - 190 mm. 




Fig. 38. 



130.5 mm. 
12S mm. 

88.5 mm. 

71 mm. 
130 mm. 



Transverse diam., - - 

Vertical diam., - 
Bi-frontal diam., - 

Bi-mastoiddiam., - .... 

Bi-zygomatic diam., - 

Anterior border foramen magnum to ant. sup. 
occipital angle, - 

The jaw in the case is poorly developed, but fairly well 
formed. In regard to the extreme tenuity of the skull, we 
do not believe that it is the result of pathological change. 
The general lightness of the bones, and the symmetry of the 
skull, are not consistent with the existence of such bone 



116 mm. 



I III III \ I 



I \< I 



III III 



changes as might produce absorption and thinning. The 
markedly dolichocephalic type of this -kull is \\ 
N '"' u of the strain of In. Man blood in the subje< I \^ has 
already been observed, the degenerate type in dolichocephalic 
crania ia in the direction of a still lower index, and in this 
instance the admixture of In. Man blood evidentlj determined 
tin- degenerative i.\ pe. This observation would appear to be 
contradicted bj the case outlined in Figs. 31, 32 and ::::. In 
this case, however, there was an admixture of negro and M«\ 
ican blood, with a resultant degeneracy of form in general as 
well as in the cephalic index. This case, in fact, partakes in 
some respects of the character of a teratological lather than 




Pig. 3 



an atavistic type,^r* -at least as far as the facial develop 

ment is concerned. 

A comparison of the prostitute's skull with the female 
Indian type next presented Bhows a marked difference in the 
cranial index, the disparity being 7.07. Even the negro in 
Pig. 34 is less dolichocephalic than this specimen. The next 
specimen, the cranium of a full-blood Bquaw of the LTncpapa 
Sioux, who was the wife of one of the leading malcontents in 
the recent Indian outbreak, and consequently of the better 
type of Indian development. 

This specimen (Fig. 39) Is exceptionally symmetrical and 
moderatelydolichocephalic. Aside from the purposes of con- 
trast, there is little of interest to Me said of it in connection with 



146 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the present series. The subject was as intelligent as the bet- 
ter class of her people average, and there is nothing to be 
said regarding her from the moral standpoint. Indeed, as 
the saying goes, the shoe might be on the other foot, as the 
Indian estimate of the Caucasian grave-robber is not a high 
one, as evidenced by his treatment of the desecrator of the 
Indian burial places when the latter happens to be caught. 
However, as our connection with the aforesaid desecration is 
very remote, we trust that our red brother will extend his 
forgiveness. 

Fig. 40 shows the same skull in lateral view. Its sym- 
metrical outline is quite evident. The measurements are as 
follows: 




Fig. 40. 

Horizontal index, - 

Circumferential, 

Anterior demi-circumference. 

Posterior demi-circumference. 

Longitudinal diam., ... 

Transverse diam., 

Vertical diam., . . - 

Over vertex from ear to ear, - 

Occipital protub. to root of nose. 

Bi-mastoid diam., - 

Bi-frontal diam., - 

Anterior border foramen magnum to superior 

occipital angle, ... - 130 mm. 

The superior maxilla presents arrested development, 



51.2 


> 
c. 


26.6 


c. 


23.8 


c. 


161 


mm. 


152 


mm. 


140 


mm. 


318 


mm. 


293 


mm. 


121.5 


mm. 


96 


mm. 



I IN III \l>. I \i I . UUv \\ |, I I I I || 



1 1: 



as well as i1m- bones of the face. The vault isoi medium 
height, and the alveolar processes well developed. [tSrill 
be found that in the Indian, as in sill primitive 
well-formed palate and regular teeth are the rule, It would 
be interesting, at Borne future time, to studj the effects of 
ch ilizatioq of the [ndian in this regard. 

The next cranium Fig. 1 1 which we will describe is the 
most remarkable of the series, and in many respects presents 
phenomenal characters. 

The subject was a half-breed Mexican and negro, wh<> 
ha. I left Mexico, his native country, for the good of his com 




Pig. 11. 

patriots. While he had never distinguished himself by any 
startling act of criminality, and had managed to keep him- 
self out of the clutches of the law, he was identified with 
the petty criminal class which forms a prominent portion of 
all social systems, and with which Mexico is especially 
infested. He finally died in a public hospital, as a result of 
some acute disease, with cerebral complications. The gen- 
eral physique of this man was trery fair, although be pre 
sented a generally overgrown and loose-jointed appearance. 
When alive he was a very peculiar Looking specimen indeed, 
the dome-shaped appearance of his cranium being exagger 



us 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



ated by a luxuriant crop of kinky wool, several inches in 
lensfth. that stood straight out from his head. From a men- 
tal standpoint he was up to the average of the negro race, 
but, morally speaking, he was decidedly degenerate. One 
of his prominent characteristics was a very irritable and 
irascible temper. 

The cranium, as is well shown in the appended illustra- 
tions, is most markedly brachy cephalic; indeed, its circum- 
ferential outline is almost perfectly round, its longitudinal 
and transverse diameters being nearly equal. The term 




Fig. 42. 

dome-shaped is as nearly accurate as possible from a descript- 
ive standpoint. It is a singular fact that the degenerate 
type of the African skull often presents the oxycephalic, or 
rafter-headed type, even when the dolichocephalous index is 
pronounced. These rafter heads are often seen. 

The skull at present under consideration is. as already 
remarked, a distinctive dome shape, which corresponds not 
at all with the rafter head. 

The peculiar conformation in this case is evidently not the 
result of pathological conditions or mechanical pressure. 
The vault of the cranium is quite symmetrically developed, 
although the base of the skull is decidedly asymmetrical, as 



i ii I HEAD, FACE, JAWS AND TEETH 149 

will shortly be shown. We know <u do mechanical n 
which might 1 1 : i \ « - cause I the peculiar dome like form of* this 
HUM. and we have been unable t<> tin* I mechanically 
deformed crania of b similar type. Such deformities as 
those presented l>\ the Chinook, or Hat head. Indians are 
quite familiar types of Bkulls mechanically deformed. I 
tain specimens found in ancient Peruvian graves are almost 
precisely identical with the characteristic Chinook type, and 
show a probable common origin of the two rac< 

There are several interesting features in connection with 
the skull under consideration. One of the most striking is 
the extreme shallowness of the orbits. This is well shown 
by comparison with some of the other types a heady described, 
the measurements being one and three-quarters inches from 
the upper margin of the orbit to the optic foramen, while in 
the Indian and negro Bkulls in this series the orbits measure 
two inches in depth. The outer walls of the orbits encroach 
upon the cavities, giving a still more marked appearance of 
shallowness. The form and index of the orbit is given con- 
siderable weight by anthropologists as a criterion of racial 
type. It is claimed by Dr. Lydston, and verified by him by 
comparative studies *^ orbital development, that the form of 
the orbit is of even greater importance as bearing upon the 
question of degeneracy oi type. That marked variation of 
the form and measurements o\' the orbit is incidental to differ- 
entiation is seen by observation of the anthropoid-. There 
is a striking difference between the member- of the Simian 
group in this respect, and a -till greater difference is notice- 
able between the wmiida and lemuridcB. The shallowness 
and obliquity of the orbit- in Fig. 4 1 is strikingly similar to 
the character- observed in the gorilla and chimpanzee, which 
are quite different from those noted in the orangs. The gen 
eral outline oi the orbit-, and their proportionate relation to 
tin' facial development, in Fig. 31, are also decidedly Simian 
in character. 

The inferior maxilla also presents some peculiarities. The 
coronoid pro. re very small and short, the body long, 

and the angles very oblique. The anterior alveolar pn 



150 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



is excessively developed. The same is true of the alveolar 
process of the superior maxilla, it being so situated on the 
outer surface of the jaw that the teeth were necessarily tipped 
in to facilitate occlusion with the lower teeth. The central 
incisors were evidently lost in early life, the alveolus being 
absorbed, and the border of the jaw only one-eighth of an 
inch in thickness at this point. The palatal vault is very 
low, and the general development of the jaws imperfect. 

There is a marked deflection of the vomer and ossm ?iasi, 
evidently of non-traumatic origin, and due to excessive 
development of the osseous and cartilaginous structures of 
the septum nasi. The nasal spine is enormously developed. 




Fig. 48. 



The cranial index in this case is extraordinarily high, being 
slightly above the maximum given by most anthropologists. 
The type is as marked in the direction of a brachycephalic 
index as is Fig. 32 in the direction of a low, or dolichocepha- 
lous index. 

Fig. 43 shows the inferior surface of the skull under con- 
sideration. A glance suffices to show its remarkable asym- 
metry. The foramen magnum is almost entirely to the left 
of the median line. A line drawn through the center of the 
foramen traverses the median line of this surface at an angle 
of about forty-five degrees. The center of the anterior bor- 
der of the foramen is situated at 76.5 mm. from the left and 
58 mm. from the right mastoid. The center of the posterior 



I ill ill \l>, I \< I . i \\\ - \M» I I J I II 



151 



boitler oi the foramen ie ,; I mm. and 61 mm. from the left and 
right mastoids, respectively. The margin oi the foramen ii 
extremely thin and the occipital rid# prominent 

The measurements are: 

98.1 



Horizontal index, 

t lircumference, 

Anterior demi circumference, 

Posterior demi circumference 

Longitudinal diam., - 



22.6 c. 
23.9 c. 
146 mm. 




m mmt^ 



: U. 

Transverse diam.. - ... [43 mm. 

Vertical diam., - - - 14 s .:. mm. 

Root of nose to occipital protuberance, - 113 nun. 

Anterior border foramen mag. to sup. occ. angle, 91 mm. 

Bi-mastoid diam., - . - L15 mm. 

Occipitomental diam., - 248.5 mm. 

Hi -frontal diam., - - 95 mm. 

Bi-zygomatic diam.. - 133.5 mm. 

Over vertex from ear to car 50 mm. 

On comparing the Longitudinal, vortical and transverse 



1 52 etiolcm n of < >»i:< >us deformit] j> < >f 

diameters of this remarkable skull with those of some of the 
others of the series, the relatively great height of this dome- 
like cranium is made very apparent. Thus the diameters 
are: 

Trans. Long. Vert. 

Fig. 31, - - 122 mm. 196.5 mm. 132 mm. 

Fig. 34. - 131 mm. 181 mm. 128 mm. 

Fig. 36, - - 130.5 mm. 190 mm. 128 mm. 

Fig. 38, - - 152 mm. 161 mm. 140 mm. 

Fig. 47, - - 140.5 mm. 180 mm. 136.5 mm. 

Fig. 48, - - 149 mm. 168 mm. 118 mm. 



Fig. 45. 

Those of the specimens under consideration being trans- 
verse 143 mm., longitudinal 146 mm. and vertical 148.5 mm.; 
a comparison with Fig. 4S is especially interesting. 

While making some observations at the Joliet penitentiary 
we discovered an example of the dome-shaped brachycephalic 
cranium which strongly resembles the extraordinary speci- 
men just described. 

This subject (Figs. 44 and 45) is a mulatto, about twenty- 
three years of age. who is doing time for attempted murder. 
He is a surly, truculent fellow, of a low e^-ade of intelligence. 



I III III \l». I \< I , I \\\ - \\ I. 1 I I I II 






and inclined to be unruly. 1 1< is at present Buffering from a 
mild type of bj philis. The form of the cranium is well worth} 

emark, the more especially as it bo nearlj approximates the 
t \ pe show ii in l-'iL r -. 4 l and • 

The facial bones, jaws and teetfa In this case w ere extremely 
well developed, and the palatal vault normal. There was do 
of mechanical compression, and as the subject was 
born in Tennessee such a cause is improbable, if not impos 
sible. 

rhe measurements were not complete. A- far as taken 
thev were: 







protuberance over vertex. 



Horizontal index. 
Root of nose to occ 
( lircumference, 
Transverse diam., 
Longitudinal diam.. 
Occipitofrontal diam.. 
I I cipito-mental diam.. 

The dome-like form of this cranium will be more evident 
on comparison of the two principal measurements with I 
of a skull of average development A comparison was made 
with that of one of the white orderlies in the prison hospital, 
a man of tine physique and good cranial development. It 
was found that while the measurement over the vertex was 



e. 
■ 

1 I" mm. 

l'.'l mm. 

mm. 

28.5 mm. 



154 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the same as that of the negro, 39.5 c. the circumferential 
measurement was 58.5 c. 

The next specimen (Fig. 46) is the skull of a noted 
Western criminal and desperado, who was lynched for train- 
wrecking in Wyoming a number of years ago. The conduct 
of this man during the progress of the lynching stamped him 
as a bravo of the most hardened type. An attempt was made 
to induce him to relate the particulars of a murder in which 
he had participated; the wife of the murdered man being 
present at the hanging and anxious to learn the details of her 
husband's death. To the persuasive efforts of the "regula- 
tors," and the tears and entreaties of the widow of his victim. 




Fig. 47. 

he replied: '*D — n it, you'll hang me if I tell and you'll hang 
me if I don't. So here goes,*' saying which he deliberately 
kicked the barrel upon which he was standing out from under 
himself and thus saved his self-appointed executioners all 
further trouble. 

This specimen is brachycephalic and chiefly characterized 
by its marked asymmetry. 

The occipital region (Fig. 47) in this cranium is excess- 
ively developed, prominent and bulging, being especially 
prominent on the left of the median line; the occipital pro- 
tuberance is situated about S mm. to the left ; the parietal 
eminences are very asymmetrical, the right being very prom- 
inent and of irregular contour; the palatal vault is of medium 
height, the teeth regular and the maxilla well developed; the 
measurements are: 



ill! HEAD, FACE, JAWS AND TEETH I 53 



1 [orizontal index. 
Circumference, ■ 
Posterior demi oiroumferent 
Tranverse diam., 
Anterior demi-circumference, 
Longitudinal diam., 

Bl frontal diam.. 

Bi mastoid diam., 

Bi-zygomatic diam., - 

Knot of nose to occipital protuberance, 

Over vertex between auditory meati, 

Foramen magnum to sap. occipital angle, 



^*s* 





j 


50. 


'■'> <'. 






! 1".. 


> mm. 


21. 


9 o. 


L80 


mm. 


L05 


mm. 


L26 


mm. 


i::i 


mm. 


312 


mm. 


327. 


5 mm. 


L28 


mm. 




kJm 



The next specimen Fig. t8) is by far the most interesting 
of the -frit-- from the standard of degeneracy, an. I i- certainly 
the most markedly asymmetrical. If it were possible to con- 
ceive of a special criminal type of cranium, this would in 
many respects be an ideal illustration. The subject was a 
noted Western desperado and train- wrecker, who was lynched 
at Carbon, Wyoming, back in the seventies, for an attempt 
to wreck a train at Medicine Bow. In this attempt he was 
bed by the individual represented in Figs. 16 and 47. 

The extremely disproportionate breadth of this cranium 
i- well shown by the above illustration. The meagre devel- 
opment of the frontal region is very noticeable. On viewing 



156 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

this skull from above, the peculiar twisted appearance which 
may be observed in connection with the cranial type of the 
criminal in general will be observed. The orbits are rela- 
tively large and the face as a whole of a decidedly u squatty " 
appearance. The absence of the inferior maxilla is to be 
regretted, although considering the vicissitudes which the 
skull has experienced, its otherwise perfect state of preserva- 
tion is rather remarkable. After the lynching of this gentle- 
man the body was buried in a hastily improvised and shallow 
grave, from which it was very promptly resurrected by those 
scavengers of the prairie, the coyotes. The skull was finally 
found by a railroad employe and subsequently used as a 
paper-weight for some years. 

Judging from the conformation of the cranial and facial 
bones, the lower maxilla, while probably well, or perhaps 
excessively developed, was without doubt asymmetrical. The 
relatively defective frontal development of this skull is its 
most striking feature when viewed in its anterior outline, and 
is best shown by comparison with Figs. 31, 32 and 31. In 
the former the extreme breadth is 122 mm. and the extreme 
length 196.5 mm., while the frontal breadth is 95 mm. In 
the skull under consideration, however, although the 
extreme breadth is 119 mm. and the extreme length but 171 
mm., the frontal breadth is only 90 mm. The great dispro- 
portion in the measurements is at once obvious. In Fig. 31 
the greatest breadth is 131 mm. and the greatest length 181.5 
mm., yet the tranverse frontal diameter is 95 mm. 

The disproportion is not compensated for in Fig. IS by 
an increased longitudinal development of the frontal bone. 

The twisted appearance of this skull is most evident on 
comparison of the parietal eminences. These are very promi- 
nent on both sides, the left being much the larger of the two; 
the occipital region is greatly deformed and exceptionally 
prominent, the bulging being most marked upon the left of 
the median line. The asymmetry of development is shown 
by a comparative measurement of the distance of each 
parietal eminence from the occipital protuberance: this 
measures on the right side 132 mm. and -on the left only 



I 111 



III \l'. I \l I . J \\\- \\l. 1 1 I I II 



i:. 



119 ram. The squatty, animal like type of thiscraniun 
shown bj a comparison of its vertical measuremenl with 
of the others of the series; from thehighesl point at th< 
to the anterior border of th<- foramen magnum, the meat 
mriii is 118 mm. ; thatof Fig nrhiofa is so distinctively 

anthropoid in its development and outline, the vertical meaa 
urement is 132 mm.; of Fig. 34, L2S mm.; of I ,140 

mm.; of Fur. 12, 148.5 mm., and of Fiflf. 17, L36.5 mm, A 
little studj of these measurements will -how the extreme ani 
mality of type in this cranium, even as compared w iili others 
of a pron< >unced degeneracy of type 





Pi«. »' 



A view from above (Fig 19) -hows the circumferential 
outline of this Bpecimen. By comparing the quadrants of 
this illustration, the pronounced asymmetry of development 
is easily seen. 

The superior maxilla in this skull is well develop*'. I. 
although the alveolar process -how- an inferior development; 
the palatal arch is exceedingly low; the left superior maxilla 
i- much smaller than the right; the palatal processes -how 
great asymmetry, the right being 61 mm. and the left hut 
5 mm. in breadth: the measurements of this cranium art 



158 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



Horizontal index, 

Circumference, 

Anterior demi-circumference, 

Posterior demi-circumference, 

Longitudinal diam.. 

Transverse diam., 

Vertical diam., - 

Bi-frontal diam., 

Bi-mastoid diam., - - 

Bi-zygomatic diam.. 

Vertical circumference from ear to ear. 



87.13 




4:9 


c. 


20.35 


c. 


2S.65 


c. 


171 


mm 


149 


mm 


118 


mm 


90 


mm 


108.5 


mm 


132 


mm 


279 


mm 




Fig. 50. 



mm, 



mm. 



Center of left parietal prominence to occipital 

protuberance, - - - - 119 

Center of right parietal prominence of occipital 

protuberance, - - 132 

Anterior border foramen magnum to superior 

occipital angle, - - - -128 mm. 

Fig. 50 is the picture of Patrick Eugene Joseph Prender- 
gast, twenty-five years of age, who shot and killed Mayor 
Carter Harrison of Chicago. October 28, 1893, at his residence, 



i ill HEAD, l \« I . i \w 9 IN D TEETH 

claiming that the mayor bad oof L r i\en him n oertain office 
which had been promised him. Prendergasl was i><>rn in [re 
land, and came to this country at the age of five years. On 

the witness stand the author gave the following testimony: 
II.":!. feel 7 inches. Weight, 132 pounds. Hair, red, 
coarse and stiff; verj little upon Face. Nose, fairly normal; 
thin at bridge, broad at ala . Ears, large and projecting; 
lobes, short and broad; tragus, both well developed; helix, 
broad, with typical tubercles at the upper and outer border 
of the .ar. Lips, upper -mall and thin, lower excessive]} 
developed; more prominent because of undeveloped upper 
jaw. Face, arrest of development of the bones of the race, 
especially at the alae of the nose. Zygomatic arches, normal, 
hut appear prominent owing to the arrest <»t' the bones of the 
Lower jaw. normal. Forehead, receding. Head, 
Bunken at the bregma; occipital portion excessively devel 
oped: circumference, 22.2 inches >">7 mm.): anteroposterior, 
7.7~» inches 20 mm.); lateral, •'-. •*'.•'. inches | h;.l mm..: lateral 
index 82; therefore extreme brachycephalic. Feet large, 
hand- normal, fingers long and -kinny. Width, outside first 
permanent molar. 2.25 inches; width, outside second bicuspid, 
2 inches: width of vault. L.25; height of vault. .7-'-: antero- 
posterior, 2. 

This individual possesses all the stigmata of Lombi 
degenerate form of insanity, paranoia. 

A- was observed in the chapter upon "Developmental 
Neuroses, " that "authors and specialists differ in regard to 
their definitions of neurotic- and degeneracy, and also differ as 
to the cases that should come under the head of one and the 
other." the question would naturally arise | after reviewing the 
different cases under consideration), i> there any difference I 
We find the same deformities in one that we do in the other. 

DEFORMITIES OF THE -I .\w Lfi BEEH IN < IMMINAI.-. 

•• Although prepared to tind a goodly proportion of 

atypical conformations of the jaw- and teeth among criminals, 

onr observations gave results which were a little surpri-iiiL r . 

There were 477 criminal subjects examined, of whom i6S 



160 



ETIOLOGY OF OSSEOUS DEFORMITIES 



were males and nine females. Of the whole number three 
were Chinese, eighteen were negroes and the remainder were 
whites, the latter representing many nationalities. 

The following table shows the different deformities of the 
jaws and teeth that were found: 









ri 


i 

o ^ 


o ^> 


i 


T3 


> B 

-< 




o — 


rt 


<u 


6 

— 


6 


M 


s 

— 

o 


i — > 

ttl 

IH 


!2 a) 

°3 


'5 <u 
i ex 


> 




— X 


> 

s 


11 


12 


= f. 


a 


£ 


X 


£ 


^ 


Ph 




~ 


> 


c/a 


si 


w 


X 


— 


T. 


468 


M 

F 


163 
9 


66 
9 


17 


5 


70 


13 


79 


l«i 


59 


30 


92 


•J 4 


Per cent. . 


36.06 


15.72 


3 . 56 


1.04 


14.67 


2 . 70 


l i;.:>(i 


3.98 


L2.36 


6.29 


L9.28 


5.03 



In the majority of the cases the jaws of the negroes were 
well developed. One had a partial V-shaped arch, one a 
saddle, one a V, and in one the left body of the lower jaw was 
found to be much smaller than the right. The bones of the 
head and face were also well developed. The three Chinese 
were all sub-microcephalic, with very small jaws, and two of 
the three had saddle-shaped arches. It is worthy of note that 
the nine females examined had large and well developed jaws, 
with normal arches/' 



CHAPTER XI. 

PROSTITUTION AND SEXUAL DEGENERAi 1 

Speaking of the olass under consideration, the M 
points out that prostitutes represent a Bpecial, degen 
erate, criminal class. Thej are more decidedly a class i>\ 
themselves than professional thieves. < >ver teu per cent are 
Illegitimate; a considerable proportion have alcoholic, syph- 
ilitic, adulterous or criminal parentage. A large proportion 
have morbid sexual propensities, and crave sexual excesses. 
A very typical, instructive history of a prostitute is that 
of AJphonsine Plessis, idealized by Alexandre Dumas in 
"Camille." Her paternal grandmother, who was half pros 
titutc, half beggar, gave birth to a son by a country priest. 
This son was a kind of country Don Juan, a peddler by trade. 
The maternal great-grandmother was a nymphomaniac, whose 
son man ied a woman of loose morals, by whom a daughter was 
horn. This daughter married the peddler, and their child was 
Camille. She had, unquestionably, the powerful perverted 
sexual instincts of many of her class. She died childless 
early in life from consumption, nature thus extinguishing the 
race. People with the ancestry, the habits, the perverse 
instincts of the prostitute class cannot be cured or reformed 
by the enforcement of municipal ordinance-. It* taken from 
their surroundings and placed where they can earn an honest 
livelihood, they, as a rule, go hack voluntarily to their old 

mode of life. And they do this despite the fact that this life 
is always a short one. and is sure to end in sickness, degra- 
dation and misery. 

Mrs. Ballington Booth,* of the "salvati on army," discuss- 
ing the "social evil," points out that a by no means small 
proportion of the prostitute class are illustrations of the 
Biblical axiom, that the "fathers have eaten -our grapes and 
the children's teeth are set on edge." 

'Quoted by Dr. Harriet C. B. Alexander in a paper read before the Chi- 
cago Academy of Medicine <Mt><li<<i/ Standard, Vol. XIII'. 

181 



L62 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

Chaplain Merrick,* of the Millbanfc (England) prison, who 
has studied prostitution from a theological standpoint, arrives 
at practically the same conclusions. Betrayal under promise 
of marriage, usually assigned as the chief cause, he finds to 
be the lowest in the list. Nearly one-half of the thousands 
coming under his observation left their homes voluntarily to 
take up u a life of pleasure.'' The most extended work from 
the purely anthropometric standpoint is that of Dr. Pauline 
Tarnowsky,f who has studied 150 prostitutes in the Russian 
hospitals and prisons. She finds, practically, that prostitu- 
tion is crime in women taking the line of least resistance. 
The prostitutes, like the other criminals, are divisible into 
criminals on occasion (vice, monetary reasons, etc.), acciden- 
tal criminals, law-made criminals, weak-willed criminals, 
periodical criminals, born criminals, and insane criminals. 
The proportion of the law-made and accidental criminals in 
the demi-monde is much less than in the other classes, as 
Chaplain Merrick has shown. Seduction stands very low in 
the list of causes. The proportion of the criminal on occa- 
sion type is very large. 

Dr. Tarnowsky concludes from her researches that the 
professional prostitute is a degenerate being, who is a sub- 
ject of an arrest of development, tainted with a morbid 
heredity, and presenting stigmata of physical and mental 
degeneracy fully in consonance with her imperfect evolution. 
The degeneracy stigmata, due to an imperfect organization, 
are manifested in prostitutes principally by the frequency of 
skull deformities (44^- per cent), and deformities of the face 
(42f per cent); by numerous anomalies of the ears (42 per 
cent), and of the teeth (54 per cent). 

The mental stigmata are shown in a more or less marked 
intellectual feebleness, in a neuropathic constitution, in a 
notable absence of moral sense. It is also evident in the 
abuse of genesic functions and in the attractions this abject 
trade has for its subjects. 

In order to determine if such conditions existed, I made, 

* Journal of Mental Science, I - 

t '' Etudes Anthropometriques sur les Prostitutees et les Voleuses." 



I III III M'. I \« I . .1 \W - \M. MINI 

id. v with Dr. Harriet C, B. Alexander and Dr. J. 6. Kier 
nan. some researches in the ( !hicago bridewell. The inn 
here are the least intelligent of an} of the class, The 
irehes are necessarily far from complete, owing to the dif 
acuities under which such researches must be obtained in 
of persons with short term sentences. They wore, however, 
habitual cases, some being in t h« • institutioD from time to 
time for twenty years, and most of them criminals. 

The number examined was thirty. Our results are as 
follows: 

Race: 

Celtic Irish, L3 

Irish-American, - - - -5 

Scandinavian, - '-'> 

German, - - - - l 

German-American, - l 

American, - - - - -2 

English-American, - 1 

Latin-Swiss, - - - 1 
Negro, - ---_' 

These results tell very little, as the "fine" system of 
Chicago places only the "obtuse" class under imprisonment. 
One was seventeen years old, two eighteen years, one nine- 
teen year-, five between twenty an<l twenty-five years, three 
between twenty five and thirty, six between thirty and thirty- 
five, five between thirty-five and forty-five, one was forty six 
year- old, two were fifty-five, three sixty, and one sixty five. 
Neither the race nor age data are of any value. There were 
eighteen blondes, ten brunettes and two negroes. Four were 
demonstrably insane, and one was an epileptic. 

In sixteen cases the /\ gomatic pr< icesses were unequal and 
very prominent. There were fourteen other asymmetries of 
the face. Three heads were Mongoloid, one Irish Celt, one 
Swiss, and one Scandinavian. There are Mongoloid 
types in the regions where the first two come. Sixteen were 
epignathic and eleven prognathic. In one there was arrest 
of development of the lower jaw, and in four arresl of devel- 



1U 



ETIOLOGY OF OSSEOUS DEFORMITIES OF* 



opment of the bones of the face. The noses were abnormal 
in six. 

There were seventeen brachycephalic and thirteen 
mesaticephalic skulls. There were no dolichocephalic 
skulls. There were three oxycephalic skulls, of whom 
one was a Celt, one a German, and one a Scandinavian. 
There were eighteen dometype skulls, of whom seven weie 
Irish Celts, five Celtic-Americans, one English Anglo-Saxon, 
one American Anglo-Saxon, and one German-American. 
There were four tectocephalic skulls, of whom one was an 
Irish Celt, one an Anglo-Saxon American, and one a Scandi- 
navian. There were three platycephalic skulls, of whom two 
were Celts and one a Scandinavian. There was one plagio- 
cephalic German and a stenocephalic Celt. One skull had a 
protuberance at the bregma. Twelve occiputs were flattened; 
in four of which there was no tubercle; eighteen had an 
enormously developed occipital protuberance. 

The following table shows the measurements and the per- 
centage of deformities of the jaws: 





!/! 


-3 




















<-> 


tN 


J= .3 


,±j 




cu 












O u 


o o. 


3 
> 

<4-l 

o 


<u 


CO 

> 


u 

a, 

ta 






•3 




*£ 


-C U 


J= -° 


XI 


a, 


"rt 


> 


CU 


rt 


CO 




*-> o 
"2 S 


S2 


%H 


_fc/) 


X! 

CO 


>-i 


s 


13 




s 




£ 


£ 


£ 


w 


> 


Ph 


c/a 


CO 


PH 


CO 


Average 


2.00 


L.69 


1.06 


49 














Per cent 










10 


17 


7 


27 


10 


10 











Twenty-nine had defective ears; eleven were of the type 
shown in figure A, nine of the type shown in figure B, and 
nine of the type C. The normal ears were present in a 
member of a family which had furnished one mother and two 
sisters to the institution. Five Celtic-Irish had type A, and 
three Celtic-Americans, seven Celtic-Irish, and one Celtic- 
American had type B. One Irish Celt and one American 
Celt had type C. One Celt was normal. .One German had 
type A. One German and one German-American had type 



I III II I \l». PACK, .1 AWN \M> I I I I II 






(' I'w o negroes bad type C. One Anglo-Saxon-American 
bad type C, and one English Anglo-Saxon bad type A The 
three Scandinavians (who were all more <»r less mentally 






defective) presented all three types. Frigerio has said (cor 
roborating a fact long ago pointed out by .Morel) that the ear 
should be placed in the first rank among the organs affected 
by degeneracy. 



166 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

Lombroso, in an examination of fifty prostitutes, found 
exaggerated lower jaws twenty-six times; plagiocephaly 
twenty-three times; asymmetrical noses eight times; prom- 
inent zygomae forty. Grimaldi, in a study of twenty-six 
prostitutes, has similar results to those of Tarnowsky, from 
whom the following is quoted: 

" Dr. C. Andronico, who, as sanitary physician at Messina, 
had to deal with a large number of prostitutes, is one of the 
first, at least to my knowledge, who has mentioned the signs 
of degeneracy in this class. He noticed among 230 girls, seen 
professionally, the following anomalies: 

Flat nose, - - 20 

Handle-shaped ears, - - 35 

Vicious implantation of teeth, 10 

Convergent strabismus, - - 2 

Facial asymmetry, - 4 

Prognathism, 7 

Receding foreheads, 35 

Let us pass now to the signs of bodily degeneracy we have 
observed in professional prostitutes. 

That which first attracts our attention is the frequency of 
cranial deformities presented by prostitutes, and which we 
have observed in women of other classes in an incomparably 
less degree. These irregularities of the cranial conformation 
reveal themselves in prostitutes by oxycephaly, platycephaly, 
stenocephaly, and plagiocephaly. * 

Many of these abnormal crania have also a notable devel- 
opment of the external occipital protuberance. 

Before continuing, I compel myself to make a slight 
digression; to say that while our observations were made in a 
hospital especially designed for the treatment of venereal dis- 
eases, there is no ground for the conclusion that syphilis has 
had the least influence in the world on the conformation of 
the crania in question. 

Out of 150 prostitutes taken at random from those 

* Archivio di psichiatria, III, 1882, p. 143. 



I ii i HEAD, FACE, JAWS AND TKKTH 167 

answering to the nccessan condit !••.! above (uniform 

it\ of race, ability to give their family history, and having 
been at least thirty three yean inmates of houses of toler 
ance), in these L50 prostitutes, we repeat, we have found 
signs of physical degeneracy in eight} seven per cent. 

The following were the abnormalities noted: 

1. Deformities of the bony cranium, Bugar loaf headi 
oxycephaly; heads flattened at the vertex platycephaly; 
narrow heads, compressed at the temples stenocephal) ; 
oblique crania plagiocephaly; heads with marked depres 
-ion- or cavities either in the region of the bregma or thai 
iA the lambda. 

All these crania] malformations may depend upon differ- 
ent causes. Among the most probable ones we will cite 
these: (1) An arrest of development of the bone; 2 prema 
ture synostosis of the sutures; (3) pathological processes 
occurring during intrauterine life, or rather, during early 
infancy, such as syphilis, rickets, scrofulous affections, 
hydrocephalus, meningitis, etc. 

Very recently Professor Recklingshausen, of Strassburg, 
has affirmed that, in infant crania, premature synostosis of 
the sutures may produce, according as one or all the sutures 
arc involved, either dolichocephaly (sagittal suture), trocho 
and oxycephaly (generalized synostosis), or plagiocephaly 
(coronary suture of one side). Professor \U cklingshausen also 
affirms that the girth of the cranium, and that of the brain, 
influence each other reciprocally, and that the form n\' the 
cranium, especially the pathological form, is ordinarily the 
result of many concurrent condition-. It may also depend 
a- much upon disturbances of the development of the 
sutural synostoses, or of the bones, a- '4)011 primordial 
(anomalies) in the development of the brain. 

The majority of the deformed head- of our prostitute- 
further -how a marked development of the external occipital 
protuberance, a peculiarity observed in one-third of our 
cases. In an equal number of virtuous women we found it 
only five times. 

Following are some illustrations of badly-formed heads: 



168 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



Fig. 51. Head flattened at the vertex; forehead hydro- 
cephalic; flat nose; lobe of ear much developed. 

Fig. 52. Head elevated at vertex; flat nose. 

Fig. 53. Development of parietal region chiefly on one 
side. 

2. The anomalies of the face reveal themselves frequently 
by asymmetry, prognathism, and a sensible disproportion 
of different parts; by a deviation of the nose, a deep exca- 
vation of the root of the nose (nose strongly flattened). 
On account of the limited number of our observations, we 
have united in our tables of signs of physical degeneracy 




Fig. 51. 



Fig. 52. 



Fig. 53. 



these various anomalies under a single head, which we desig- 
nate anomalies of the face. 

3. The ogival palatine vault, although making a part 
of the facial anomalies, has been noticed by itself as a dis- 
tinctive characteristic sign. We have been surprised to see 
it so often. 

4. The complete division of the palate. Suture of the 
bones of the palate remaining open. 

5. Defective teeth, irregular in growth, riding over 
each other, or, on the contrary, widely separated; teeth 
notched and grooved (Hutchinson's and Parrot's teeth); 
teeth encroaching outside the dental arch, of which they 
render the parabola irregular; and finally the atrophy or com- 



1 111 in \i>. i \< i . i lws \m» i iii ii 169 

plete absence of the superior lateral incisors. The wisdom 
teeth are vet} often lacking. Ln her excellent thesis of 
inauguration, Madam Alice Sollier noted the dental anoma] 
iefl vt-rv common in the degenerates: lt Idiocy, irith or with 
out epilepsy, predisposes to arrests of development to 
anomalies, and to lesions of tin* dental apparatus in a large 
proportion eighty one per oent." 

6. Anomalies of the ear. In the first place, we notice 
the i»:nll\ bordered ear, with excavated helix, described by 
M. Morel. Next, defective implantation of the ears, 

in the form of a handle; the ears with pointed tops, Bur 
mounted by the tubercle of Darwin; fleshy car-, with large 
lobules, also ears with sessile lobule-. 

7. Anomalies of the extremities. Congenital, lack of one 
phalanx, club foot, valgus and varus. 

v . Loral asphyxia of the extremities. 
All the anomalies enumerated below arc thus distributed 
among L50 prostitutes: 

Malformation- of the head (oxycephaly, plagiocephaly, etc.) 
noted in - 62 women 

Development of the occipital protuberance, - 62 women 

Very receding foreheads, - - - 18 women 

Hydrocephalic, - - - L5 women 

Various anomalies of the face (prognathism, asym- 
metry), - - - - - ♦14 women 
Ogival palatine vault, - - - 38 women 
Congenita] division of palate, - - -14 women 
Vicious implantation of teeth. - 62 women 
Hutchinson's and Parrot'.- teeth, - 19 women 
Absence of lateral incisors, - - 10 women 
Badly margined ears (Morel), - - 16 women 
Defective ears (detached from head, deformed, 

etc. i. - - - - - 17 women 

Anomalies of the extremities, - - - 8 women 

Local asphyxia, .... L > women 

It is evident that the possessor of one of these anomalies 
alone should not be considered as an abnormal being. It is 



1 7' I ETIOLOGY OF OSSEOUS DEFORMITIES OF 

only the coincidence of many of these deviations in the same 
person, connected often with moral abnormalities, that cause 
them to be regarded as signs of physical degeneracy and as 
connected with any hereditary defect. 

In our prostitutes these physical anomalies have been 
found in the following numbers in the same individuals: 

In 15 prostitutes, a single anomaly, or one in ten per cent. 

In 34 prostitutes. '2 anomalies at once, or 22.66 per cent. 

In 35 prostitutes, 3 anomalies at once, or 23.33 per cent. 

In 30 prostitutes, 4 anomalies at once, or 20 per cent. 

In 14 prostitutes, 5 anomalies at once, or 0.33 per cent. 

In 66 prostitutes, 6 anomalies at once, or 6 per cent. 

In 4 prostitutes. 7 anomalies at once, or 2.66 per cent. 

In 1 prostitute, 8 anomalies at once, or 0.66 per cent. 

Eliminating the first 15 women presenting only one anom- 
aly, and who cannot, therefore, be classed as badly organized 
individuals, and adding one prostitute who showed no physi- 
cal deviation, we find that the other 134 prostitutes show, in 
82.6 per cent of the whole, more than one anomaly at the 
same time. In comparison with these, respectable women, 
both illiterate peasants and cultured females, show an enor- 
mous difference. Thus, amongst educated women, we found 
only two per cent of anomalies, and amongst illiterate peas- 
ants, 14 per cent. 

We take occasion here to recall the fact that our prosti- 
tutes were not especially selected as they were admitted to 
the hospital; all were taken who fulfilled the requirements as 
to race, ability to furnish the needed data, and who were not 
disfigured by syphilis. 

^«> striking a difference between respectable females and 
prostitutes cannot be merely accidental. We believe that 
such a notable frequency of the stigmata of degeneracy in 
prostitutes is to be accounted for, at least in great part, by 
their family histories, which show, as we shall see in the next 
chapter, many of the causes predisposing to hereditary defect. 
a- well as to arrests of development." 

In concluding this chapter. I cannot but agree with the 



i ill BEAD, FACE, JAW8 AND TEETH 171 

conclusions of Dr, Harriet C. B. Alexander, based on oar 
Chicago researches, that the general propositions of I>i 
uowskj are borne oul bj these results, albeit degeneracj 
stigmata are more frequent :niMiiL r these Chicago specimens. 
More extended researches are needed, and if is t«> be hoped 
that physicians to allied Institutions will not fail to cultivate 
this field. The results of Mrs. Ballington Booth and Chap- 
lain Merrick >how thai these beings need treatment along 
physical lines laid down in institutions like the Blmira 
reformatory. Like the pauper and criminal, the prostitute 
is an atavistic survival of primitive states, out of accord with 
existing tendencies, but arising from degeneracy due to bad 
hygiene and its resultant moral and physical effects. 

8EXI \i DEGENEK \< J . 

An allied class, belonging to a -till blacker phase of the 
night side of nature, are the sexual perverts; but one phase 
of sexual degeneracy can be dealt with here the congenital 
form, which is associated with the Btigmata of degeneracy as 

an expression of the defective line from which the victim has 
Bprung. These differ in toto from the perversities or vice 
types fittingly relegated to the works on jurisprudence. The 
congenita] type, as Dr. (r. Frank Lydston has shown, are 

victim- i)\' inherited defect. It often Links the degenerate 

lunatic-, epileptic-, etc., with the horn criminal class. 



CHAPTER XII. 

MORAL INSANITY, PAUPERISM AND INEBRIETY. 

There has formerly been much discussion of the subject of 
moral insanity, and it has been affirmed and denied with equal 
vehemence that there existed a form of mental disease to 
which the term " moral insanity " could properly be applied. 
It is seen, however, more recently that there are many insane 
persons in whom the principal difference from the normal 
consists in disease or defect of the moral faculties; while it 
is also true that in most such persons a closer inspection gen- 
erally reveals other signs of mental disease, defect or degen- 
eracy (using the word " mental" to designate the whole 
mind), besides simply immoral conduct, and that somatic 
signs are also present. In such cases, however, the seeming 
immorality is often the striking factor of the case, and the 
mind of the individual superficially appears clear and 
rational, which fact led early writers (Prichard, 1842,) to use 
the term in question. Later a controversy grew up in which 
one party protested against moral insanity being used as a 
cloak for depravity and the other insisted that many so-called 
immoral acts were the outgrowth of disease or inherent 
defect of the moral faculties. Such a controversy was often 
bitterly waged by the opposing sides in criminal prosecu- 
tions, and remarkable forensic contests of this nature have 
served to further obscure rather than clear up the subject. 
In some of these contests guilty and responsible criminals 
have escaped the consequences of their crime, while other 
persons innocent from imbecility, chiefly of the moral facul- 
ties, have been unjustly punished. Moral insanity is today 
an accepted form of disease of the mind, and presents features 
whereby it may be differentiated from depravity, or guilt of 
a responsible individual. 

Krafft-Ebing, a German writer of authority, thus 
expresses himself with reference to this form of insanity: 
"If we seek to sketch the clinical signs of this peculiar 



i iii 111 \i». i \< i . JAWS \M» i i i i ii 

defective Btate, we find as the most striking appearance, 
moral insensibility, a lack of mora] judgment and ethical 
idea-, the place of which is usurped by sense of loss or profit 
onrj Logically apprehended. Such persons may mechanically 
know and remember the laws of morality, but if such laws 
enter their conscience these persons are not affected by anj 
real appreciation, still !»■-- bj regard for them, These laws 
are cold and lifeless statements, and the morally defective 
know not how to draw from them any motive for omission or 
commission of an act " 

To this u moral color-blindness" the whole moral and 
governmental order appears only as a hindrance to egotisti- 
cal ambition and feeling, which necessarily leads to negation 
oi the rights of other- and to violation of the same. These 
defective individual- are without interest for aught that there 
i- good, beautiful, and insensible to all influences of the heart. 

Such persons are repellant by their lack of love for children 
or relative-, and of all social inclinations, and by cold-hearted 
indifference to the weal or woe of those nearest to them. 
They are without care for questions of social life or sensibil- 
ity to either the respect or the scorn of others, without con 
trol oi conscience, and without sense of remorse for evil. 
Morality, they ^U> not understand. Law i- nothing more 
than police regulations, and the greatest crime only the trans- 
gression of some arbitrary order. If such persons come in 
conflict with individuals, then hatred, envy and revenge take 
the place of coldness and negation, and in their moral idiocy 
their brutality and indifference to other- know no hounds. 
These ethically defective persons, who are incapable of 

holding a place in society, arc converted sooner or later into 
candidate- for the workhouse, the bridewell or the insane 
asylums, one or the other of which places they reach after 

they have been as children the terror of parents and teachers 
through their untruthfulness, laziness and "general cuss- 

edne— ." and a- youth the shame of the family and the tor- 
ment oi the community and the officers of the law by theft-. 
vagabondage, profligacy and excesses. Finally they are the 
"despair" of the asylum and the u incorrigibles " i)i the 



174 ETIOLOGY OF OSSEOUS DEFORMITIES 

prison, and, Krafft-Ebing might have added, the mere burden 
of the poorhouse, since a large number of them pass into 
fatuity and imbecility as a terminal stage of their career. It 
may be said that if madness or crime do not claim them, pau- 
perism is almost certainly their destiny. 

Physical signs of defect and degeneracy are usually to be 
found with such individuals — asymmetries, paralysis, mal- 
formation, especially of cranial bones and teeth; the facial 
expression, the movements and the gait, are often suggestive 
of the abnormality of mind. In a large majority of such 
cases also, epilepsy, drunkenness or insanity will be found in 
the ancestry. 

INEBRIETY. 

Among ethical degeneracies is naturally included ine- 
briety. Under this head may be properly classed those 
cases of periodic morbid impulse to drink, which are com- 
monly classed as dipsomaniacs. This morbid state is best 
studied under two distinct heads — inherited and acquired. 
Both conditions may be associated with neuroses and degen- 
eracy. Inebriety may be inherited direct from the parent, or 
the individual may have inherited a neurotic or degenerate 
nervous system from his parents, who are victims of other 
excesses or disease, such as syphilis, cancer or tubercular 
diathesis, etc. In such cases the individual, in almost every 
instance, displays somatic stigmata. Such persons, exposed 
to evil influences through society, soon become dipsomaniacs. 
Such is the history of a large percentage of those who visit 
the Keeley institution. There is properly no one condition 
that produces so many forms of the degenerate in the off- 
spring as that of inebriety. In a later chapter are discussed 
the results of this disease. 



CHAPTER Mil. 

IN rELLECTC \L DEGENERACY 

Intellectual degeneracy reveals itaell chiefly under the 
forms of insanity, imbecility and idiocy, and is often acconi 
panied with cranial, facial and dental irregularities. In addi- 
tion to these, the unstable conditions of the nervous system, 
evident in the symptoms of idiopathic epilepsy or hysteria, 
slmuM be placed in this same class. But, Bimple insanity, 
uncomplicated mania or melancholia, not connected with any 
qic lesion or recognized bodily disease, is not necessarily 
connected with any facial or cranial defects, nor is it to be 
considered as essentially indicating any intellectual degener- 
acy. Causes sufficiently powerful may produce these derange- 
ments in the brain of normal individuals, even above the 
average in mental and physical vigor. This is true also of 
the insanities connected with many bodily ailments, and. t<> 
some extent, of delusional insanity or paranoia, and many 
- of periodical or remittent insanity. In many of these 
last, however, and in some cases of paranoia, there are blended 
Btigmata of degeneracy. Of the developmental insanity of 
puberty (adolescent insanity or hebephrenia), often due to 
congenital structural deficiencies, the same is frequently true. 

These cases fall under the head of vicious organization, of 
which insanity is the result. Under this class come, per- 
haps, first, the degenerative paranoiacs (the origin* 

'ctheit of the Germans), in which it is the rule to find mis- 
shapen crania and asymmetrical features, necessarily involv- 
ing deformities of the bony part-, often extensive and charac- 
teristic. These patient- are usually included among the para- 
noiacs, but there i- a wide difference between them and the 
typical case of primary or secondary delusional insanity. The 
born criminal- of Lombroso also fall into the degenerate class. 
They are the victims of heredity and organization, though 
none the Less dangerous on this account. Manx 
hysteria also bear the stigmata of degeneracy. There are 



i 



176 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

numerous exceptions, however. These are often impressible 
females, unequal to the stress of natural physiological require- 
ments. Whatever stigmata of degeneracy they may display 
are to be found in directions other than those of gross defor- 
mities due to irregular skeletal development. 

The great neurosis, epilepsy, is very often characterized by 
facial and cranial deformities. Epilepsy, in fact, is only a 
symptom of an organic cerebral defect that very often reveals 
itself in part by cranial and facial anomalies. The epileptic 
fades is readily recognized, even by laymen who have had 
much to do with these unfortunates. Dr. H. M. Bannister 
tells me he once tested this by a composite photograph of a 
number of epileptics, taken at random. Even with the imper- 
fect methods used, the rather vague photograph was readily 
recognized by a number of asylum employes as that of an epi- 
leptic, and by some mistaken for the imperfect likeness of a 
certain typical epileptic not included in the number who con- 
tributed to the picture. 

It is difficult to say of just what this epileptic fades con- 
sists, but it is due to facial irregularities in which the eyes and 
jaws largely participate, aside from the accidents to which 
they are liable from their disease, that frequently produce 
deformities. Congenital epileptics (especially insane epilep- 
tics) have very markedly misshapened, plagiocephalic crania, 
deformed or ill-proportioned jaws and facial bones: irregu- 
larities in the teeth appear to be very common among them. 
Some cases of so-called idiopathic epilepsy are probably due 
to traumatism received at birth, and many more to the results 
of natural causes acting in early infantile life, especially teeth- 
ing, often accompanied with nervous disturbances. Often 
these derangements are excessive, and the yet unformed nerv- 
ous system receives a bias toward instability which affects 
the whole future life of the individual. Infantile convulsions 
of the teething period may give rise to epilepsy in the youth 
or adult. Where there is not direct passage from one to the 
other, there may be created a predisposition to the latter dis- 
order that then requires much less than the ordinary cause to 
produce it. When this is the case, any later disturbance 



I II I II I \l>. I Ml . JAWS \M» I I I I II 






which would probably have little effect on b normal system, 
nia\ produce the most serious results, rhe second dentition, 
which is not without its influence on the general nervouc 
tnii. though it ordinarily causes little trouble, may in indi 
viduals thus prepared bj prior instability, especially when 
complicated by anatomical or dental abnormalities, cause epi 
lepsy or other neuroses, including insanity. Thus may 
result a direct connection between dental and mandibular 
deformities and mental and nervous diseases. The anomalies 
of the jaws and teeth, as regards their relation to mental and 
nervous diseases, may be divided into three classes, as 
follow s: 

First, Those in w hich the brain symptoms and the maxil- 
lary anomalies are both due to the same cause, and arc 
mata of degeneracy (the deformities as in idiocy, imbecility, 
some form- ^\ systematized and hereditary insanity). 

s <</. Those in which the maxillary deformities are due 
and secondary to the central disorders as in the accidental 
deformities of epileptic- and the atrophic- observed in connec- 
tion with certain brain lesion- . 

Third. Those in which the symptoms involving the nerv 
on- center- are secondary and consecutive to the deformity 
(neuroses from irregular dentition). 

The practical importance of this last class will be readily 
appreciated. A- dental or maxillary deformities are dan- 
gerous in neurotic individuals at special periods of life, their 
early correction becomes ^t' the highest importance. The 
operator must therefore he able I aize these conditions 

in order that he may guard against complication-. I know a 
neurotic patient, thirteen years of age, who developed 
epilepsy as a result of having her teeth regulated. The 
necessary pressure exerted to remove the teeth developed the 
disease. I i\\-^ know a patient, of a nervous temperament, 
confined to her bed two years as a result of improper care 
of the general health while the teeth were being regulated. 
The operator failed to recognize an unstable neurotic temper- 
ament. These condition- are very common at the period 
when the deformities of the jaw- arc usually corrected. The 



178 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



nervous system is in a critical period of development. This 
is particularly true of females. 

In the great mass of the insane of the Northern United 
States, dental and maxillary anomalies appear to be excess- 
ively frequent. The following table shows the results of the 
examination of the jaws and teeth of 700 insane cases of 
patients taken at random (without regard to the nature of 
the disease) in the asylum at Dunning, Cook County, Illinois: 



MAXILLARY DEFORMITIES AMONG THE INSANE. 



6 


V 

in 





tr. 


.2 7 
2 - 

Q 


c ^ 
1 £ 

— 


rt 
> 

Tr. 


4J 

— 

— £ 


1'artial 
V-Shaped 

Arch. 


Saddle 
Shaped 

Arch. 


h 
£ 

X. 


430 
270 


M 
F 


347 
130 


10 

8 


4 



• > 
4 


18 
26 


12 
14 


29 

18 


3 
9 


5 


700 




486 18 


10 


G 


44 20 


47 


12 


7 



In the next table we have the results of measurements of 
over 600 inmates of the Illinois Eastern Hospital for the 
Insane at Kankakee, classified according to the general type 
of their disorder: 



I III 



III \l». 1 \( I . .1 \\\ S \\|i || 



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ISO ETIOLOGY OF OSSEOUS DEFORMITIES 

The high vault is not conspicuous among these patients. 
Some of the irregularities were due to local causes, and 
the others were among cases of congenitally insane patients, 
or those who had become insane early in life. Most of the 
700 were chronic cases, in whom confused derangement had 
followed an uncured simple insanity, mania or melancholia; 
the types, which as has already been stated, are not neces- 
sarily or probably connected with stigmata of degeneracy in 
facial or bony deformities. Tn such the outlines of the skel- 
eton are, as a rule, well established long before any abnormal 
condition of the brain had made its appearance. Such 
patients, in fact, make up the greater part of the inmates of 
public institutions. It is not there that a very large percent- 
age of deformities is to be expected. They are in this coun- 
try, especially in its central and western portions, very largely 
of foreign birth — normal individuals of the lower orders of 
society, and of only moderate intellectual power and resist- 
ance — who, under the strain of the struggle for existence in 
new and often unfavorable conditions, have broken down 
mentally. They are not necessarily degenerates, but are 
mediocrities unable to undergo what are to them extraordi- 
nary conditions. An examination of these individuals under 
their different headings, however, may show a considerable 
percentage of deformities. While many of these persons do 
not show stigmata of degeneracy as regards their jaws. 
marked deformity of the face, ears and head were noticed in 
those persons who did possess deformities of the jaws and 
teeth, showing that the brain was defective at birth. 



CHAPTER XIV. 

NEDROTK - 

A. definition has already been given of the term "neurotic/ 1 
and mention made of the differences of opinion in reg 
to its signification. The term neurosis Is applied to a large 
class of nervous disorders without a well-defined charact 
tic anatomico-pathological basis; :in<l the word "neurotic," 
therefore, implies general indefinite tendencies to nervous 
disorders in the constitution of the individual. In its widest 
sense, and when used as a noun implying individuals, it may 
also include those who arc Buffering from minor chronic 
nervous ailments, a- well a- those who. from heredity or oth- 
erwise, arc particularly liable to disorders of the nervous 
system. In this Bense, a neurotic i- not necessarily a degen 
crate, anil while he may -how some abnormalities in hi- phys- 
ical organization, they are not to be considered a- always and 
essentially the stigmata of degeneracy. Thus, deformities of 
the bones are apparently a- common among neurotics 
among degenerates, and the same nervous defects of nutri- 
tion that give rise to them in one may produce them in the 
the other; but the evidence- of a neurotie constitution do not 
imply any such general defects a- would involve the perpet- 
uation of the species, a- in the case with degeneracy. What 
is deficient in one direction seem- often to l>e compensated 
for iii another, and even when this is not obviously tin' i 
there -eem< to he a resiliency above the average. Neurotics 
are often long lived, peculiarly resistant to certain acute and 
fatal diseases, and are frequently noticeably retentive of their 
youthful appearance, which is, i" a certain extent, an evidence 
of their resistance to the wear and tear of life and advancing 
old S£ 

The fact oi the neurotic tendency often induce- the indi- 
vidual to take better care of himself, and the youthful 
appearance may be due largely to arrest of facial develop- 
ment at an early age, thus retaining the miniature character 
throughout life. ( Sonsidering, therefore, this class of neurotic-. 

181 



182 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

which does not include those afflicted with the more serious 
nervous disorders, such as epilepsy, they may be looked upon 
as the victims of evolutionary processes that are constantly 
<roimr on in the race and under civilized conditions. Neu- 
rotics are not met with to any extent among barbarous races, 
but are numerous in civilized communities, where the weak are 
preserved from early death, and then subjected to the struggle 
for existence under the complicated and artificial conditions of 
modern civilization. Neurotics are naturally imperfect indi- 
viduals in some directions, but they are often superior in 
others. Their disordered nervous functions and hyperesthe- 
sias are not necessarily indicative of any inferiority of gen- 
eral organization. They may simply imply a more rapid 
advance in some one direction in the development of the 
nervous system than can be readily accommodated to b}- the 
remainder. These defects themselves may in some cases be 
the advance guards in the progress of the development of the 
race. As the nervous system controls nutrition in all depart- 
ments of the organism, we would naturally look for anoma- 
lies with erratic nervous functions in these individuals. In 
these neurotics we often find a defective development involv- 
ing the bony and other structures. They have fine and deli- 
cate features, small jaws, and defective teeth. These are the 
results of general systemic modifications connected with the 
neurotic state. But, besides these, special nervous disorders 
directly affect the nutrition of the jaws, the most notable 
instances of this being the diseases called acromegaly and 
facial hemiatrophy, the one causing maxillary hypertrophy 
and the other not infrequently unilateral atrophy of the jaw. 
In this connection, also, may be mentioned the arthritic dia- 
thesis, which is one of the underlying conditions of many 
neurotic manifestations, and which is responsible for many 
acquired bony deformities, not infrequently involving the 
jaws to some extent. 

Overdevelopment of the brain and nervous system, but 
especially of the higher brain centers, which is the tendency 
of modern life, is not invariably followed pari passu by a 
corresponding growth of the other bodily organs and func- 






i ii i 111 \i>. i \< i . JAW8 w i' i i i i ii 183 

Lions, and their unequal reaction to the demands of the higher 
organ ia the source of a large crop of neuroses. There is, in 
this way. m somewhat mora remote, but -till probable, 
mechanical cause for cranial deformities and nervous disturb 
ances, in the increasing size of the infant brain, with conse- 
quent enlarged bead at birth, and the not correspondingly 
developed female pelvis, rendering birth more difficult, thus 
increasing the chances of injury to the skull and contents, 
and laying the foundation for future disturbances. III- 
assorted marriages, as regards mental and physical character 
istics, intermixture of races, and, more perhaps than anj 
other cause, the excessive -train- of both mind and body in 
the struggle for existence in the existing conditions of lit'*'. 
the tendency to urban residence, with a resultant artificial 
ami unnatural condition of life, immorality and disease, all 
have a tendency to increase tin 1 number of neurotics and 
degenerates, which is only partially compensated for by the 
reduced tendency to intermarriage due to the migration and 
congregation of Large masses of the population. There i- 
liable to he less concentrated hereditary taint in proportion 
to the population than in quiet, long-settled rural districts, 
hut there is a vastly greater proportion of acquired defects 
in tlie city population. It i- in connection with neurotics 
that specialists find a rich tield tor their investigation of 
deformities of the jaws and teeth and other special diseases 
i^f the eye. car, nose, throat and Lungs. This da-- of indi- 
vidual- are most common among the better classes, although 
the negroes of America are fast developing neurotic and 
degenerate tendencies. The reason for this lies in the fact 
that when weak, -ickly children arc horn among the nobility 
of Europe, or ^( well-to-do people of Europe or America, the 
family physician is frequently called, and the best of care i- 
taken of them. They are removed from one climate to 
another, thus avoiding the extreme heat and cold ami other 

deleterious influences. By this mean- the life of the individ- 
ual is prolonged. In this way, -o far as the physical organi- 
zation is concerned, we have an example of the survival of the 
untittest. These people, bychange of climate, pass the critical 



184 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

point in youth and middle life, and frequently become our beM: 
business men and women, although the taint of disease is still 
lurking in the system, and is handed down from one genera- 
tion to another. Of these individuals, many possess defect- 
ive osseous and nervous systems, which are either inherited 
direct, or the neurotic or degenerate condition may be inher- 
ited, as the result of which arrest or excessive development of 
any of the tissues of the body may take place in the offspring. 
Thus, father or mother may possess a large or small face or 
nose, weak lungs, or abnormal brain development, or any of 
the conditions noted under the heads of nutritive, degen- 
eracy and local reversion tendencies; or on the other hand, the 
child, by inheriting the neurotic condition in otherwise 
healthy parents, may develop any of these conditions at some 
period in his or her life. A few illustrations will not be out 
of place at this time, and will serve to impress more fully 
upon the mind of the reader the points which the author 
wishes to convey. 

The cases most interesting and important are those of the 
development of the child. Neurotic and degenerate symptoms* 
from a mental standpoint are noticed long before deformities 
of the osseous system are developed. They show themselves 
in the form of mental weakness, varying from idiocy to 
imbecility and extreme stupidity on the one hand, and 
precocity on the other. Under the first class, the child 
is obstinate, quarrelsome, malignant and even immorally 
inclined, and is often spoken of as being wicked or vicious. 
Dr. Harriet C. B. Alexander- says the ruling instinct in the 
child of three or four is self-gratification, involved in which 
is a tendency to destroy what is disliked. Among the earli- 
est manifestations of morbid mental activity in childhood 
are hallucinations which depend on already registered per- 
ceptions. In many instances even moral agencies produce 
sudden explosions of mental disorder. The inherited ten- 
dencies of childhood predisposes to these attacks. As 
Clouston has shown, neuroses and psychoses not requiring hos- 
pital treatment are by no means uncommon in the too sensi- 

*The Medical Standard. April. 1893. 



I III III M-. I \< E, JAW8 AND TEKTII I JO 

tive child with hereditary taint Children ot this claw have 
crying fits and miserable periods <>n Blight or no proi 

nun. Houston al-<> nays precocity, over sensitivei 
unhealthy strictness in morals and religion for a child, a too 
vivid imagination, want of courage, thinness, and cravin 
animal food, are common characteristics. These children are 
over-sensitive, over-imaginative, are too fearful to be phy- 
siological, and tend, as a general thing, i<> be nnhealthfully 
religious, precociously intellectual, and, al first, byperwsthet- 
ioally conscientious. 

The other class of ohiidren, as a rule, arc very handsome 
babies and children. Their brightness is noticed by the 
parents at a very early age, and they extol their many bright 
qualities and sayings. The tendency is for the parents to 
cultivate these precocious qualities, and believe it to l>e the 
proper thing to encourage them. While in early life they 
ma\ possess the peculiarities of the other das-, tiny also show 
those of degeneracy. These children are the best scholars in 
tin- schoolroom and learn their h— on- with apparently little or 
no study. They are usually thin, frail children, and very 
nervous. Children of both classes arc Bure to -how stigmata 
of degeneracy. This period of degeneracy commences at 
the -i\th year, at or about the time the first period of brain 
development ceases. The bulk of the brain ha- obtained its 
growth. In some the cell- begin to develop and the child 
commences to improve mentally very fast. In others mental 
development i- bIow. In -till others it ceases altogether. 
From the time the second Bet of teeth begin to develop, until 
the twelfth year, neuroses of development and Btigmata of 
degeneracy are -tamped upon the head, face, nose, jaw- and 
teeth, and later any of the condition- mentioned under the 
heads of nutritive degeneracy and local perversion tendencies 
may appear. In a class of sixty-four students, who graduated 
with the author, eleven were exceptionally brilliant; all were 
neurotic-: most of them showed deformities of the head, face 
and jaws. The attention of the author was attracted to them 
because they always answered questions in the "quizzes" 



1 86 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

promptly and fully, without hesitation or preparation. Only 
four of these men have made successful practitioners. The fol- 
lowing cases are here mentioned to show the stigmata trans- 
mitted to the children. 

NECROTIC CASES. 

Case I. — Father, a retired coal merchant, shows marked 
stigmata of degeneracy, head hydrocephalic, left eye con- 
siderably higher than right, nose deflected to the left, face 
arrested at the alae of the nose, upper jaw small; is very 
close and mean in his dealings with others; is considered 
peculiar; he had attended personally to the building up of 
his fortune. Mother apparently normally developed. They 
have two daughters; both have inherited their father's head so 
far as size is concerned; the upper jaws are unlike. Both 
parents have hypertrophy of the alveolar process. The old- 
est daughter, sixteen years of age, is unusually bright in 
school, while the youngest girl, twelve years of age, is an 
imbecile. 

Case II. — Father, an exceptionally bright man, well-to* 
do, has no business except the care of his property; spends 
most of his time doing missionary work; is of a nervous 
temperament; at one time became partially insane upon the 
subject of religion. Mother very bright, but not healthy; 
has had three children; oldest, a daughter, died at the age 
of eighteen, of tuberculosis; of the other daughters, one six- 
teen, the other twelve years of age; the one aged sixteen 
has no ambition to do anything, while the youngest has 
inherited a nervous temperament, is very bright at school, 
and a fine pianist. All the children possessed deformities 
of the jaws, face and teeth; the two youngest are mouth- 
breathers. 

Case III. — Father, a very prominent lawyer, had made a 
great deal of money in his profession, and at one time was very 
wealthy, but being an indulgent man he allowed his family 
all the luxuries of life, consequently his three children became 
spendthrifts, and he died at the age of sixty-eight a poor 
man. The mother was a very fine Avoman. but with little 



I II I HEAD, FACE, fAWS AND TEETH 1*7 

education or force of character. The oldest, h son, an epil 
eptic; the two youngest, daughters; both were married, but 
their husbands left them; they were prostitutes before mai 
riage, and have been going down liill ever since; the 
youngest ban become insane from the use of morphine :m<l 

tine, and is now in tin- asylum. All inherited the u j »j ><*: 
j.-iw of tin- father, which was arrested in its development 
with a partial V- shaped arch. 

Ca8i [V. Father, a minister, of Scotch descent ks i 

icher is a success, baa a full congregation at every serv- 
ice. As a business man has no ability, and does not seem to 
know right from wrong. In dealing with people, he does 
not seem to know the first principles of honesty; it is diffi- 
cult for him to speak the truth: indeed, he forgets all about 
previous obligations, and if it is for his interest to state a 
falsehood, he does not hesitate to do so. The mother is an 
ptionally bright woman; for five years used to write 
her husband's sermons. The minister has two sisters; one 
the author has never seen: the other is even more untruthful 
"than the brother. There are five children, three boys and 
two girls; three of the children have myopia; two have 
arrest ^\ development of the bones of the face; two, arrest 
of development of the superior maxillary hone-, with partial 
V-shaped arches, one has inherited the family trait of being 
very untruthful. The jaws of father and mother are normal. 
The neurotic condition of the children in this case inherited 
the defective brain which presided over and developed a 
defective osseous -y-tem. 

Two other similar cases — one a physician, the other a trades- 
man — have come to the notice of the author in which the chil- 
dren have not only inherited a neurotic constitution, result- 
ing in stigmata of degeneracy, but have :\\<i^ inherited the 
art of lying. This inherited trait, or art of untruthfulness, 
not unlike kleptomania. 

Case V.— That children may inherit a neurotic tempera 
ment without apparent cause, is nicely illustrated in the fol- 
lowing case: Father, forty-six year- of aire: mother forty-two 
year-: both perfectly healthy, with the exception that 



188 ETIOLOGY OF OSSEOUS DEFORMITIES 

the father has had sick headache more or less all his life; other- 
wise neither has been sick a day. Stigmata not noticed in 
either case. There are two children, one a daughter, 
sixteen years of age, and a son, nine years of age. The 
daughter has, and will retain a youthful face; has arrest 
of the upper jaw and a V-shaped arch; is unusually bright 
at school. The son has arrest of development of the 
bones of the face; the teeth are backward in their develop- 
ment, and therefore are not far enough advanced to indicate 
what the shape of the arch will be. Both of these children 
have had scarlet fever, and the boy has had a bad attack of 
pneumonia. It is quite possible, and I think probable, that 
the neurosis, with the stigmata, is the result of these con- 
stitutional diseases. Both children are apparently healthy 
and well. 



CHAPTER XV. 

GENIUS 

Ever)' oitj the world over has its brilliant men and women 
journalists, editors, singers, artists. Critical examination i>\ 
:i physician would reveal in them a large majority of oeu 
rotics, :m<l man) of the most successful business men would 
undoubtedly be classed under the same head. Similar classi 
fication in skilled mechanics would produce Like results. In 
all the face, jaws and teeth would bear the stigmata of 
degeneracy. To clearly comprehend the bearing of these 
observations, definition of the term genius, used as a subject 
for this chapter, becomes necessary. 

Huxley Say8: "Genius i- innate capacity of any kind 
above the average mental level"; or, a genius Is one who Is 
endowed with excessive mental development in some one 
direction. Much has been written on genius as a neurosis or 
evidence of degeneracy, [f genius he capacity for work and 
power of concentrated attention, such as has characterized 
many of the world*- greatesl men. then it certainly cannot 
be considered a morbid phenomenon, as these are proper 
attribute- of perfect mental and physical organization. The 
average normal individuals, and indeed, the greal ma-- of man- 
kind fall very short of perfection in these respects, and the 
few who approach it are from their achievements popularly 
classed among the geniuses of the age. The world occasion- 
ally sees an encyclopedic ir^nius, with capacities developed in 
many direction-. Admirable Crichtons, however, are so rare 
a- to he merely the exception- to the ride, which provi 
validity, that greal men are irregularly developed, and that 
the more brilliantly Light is focused on one point the more 
apparent the contrast with the surrounding obscurity. 'Hie 
defects of these individual- are therefore the more prominent. 
It does not follow, however, that they are naturally imper- 
fect or degenerate individuals; they simply illustrate the limi- 
tations of the human mind. it> inability to concentrate a.-tivi- 



190 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

ties except in a narrow sphere. Long continued devotion to 
one line of study may destroy or impair normal capacity in 
other lines. Charles Darwin complained that such was the 
case with himself; that in his later years he had become a mere 
machine for making generalizations upon data of natural 
science. 

So much for what may be called normal geniuses, who 
comprise the vast majority, to say the least, of those who 
have done epoch-making work in the world's progress. 

There is another class to whom the world attributes 
genius, and in many cases justly, who are irregularly 
developed from the beginning, and are hence unbalanced and 
imperfect individuals. These show precocious aptitude in 
certain directions, and astonish the world at once with their 
brilliance and their erratic performances. These have often 
a heredity of talent, but equally often a heredity of taint. 
The old adage that "great wit and madness are allied" seems 
to be verified often in their histories. Inborn talent in one 
direction makes an irregularly developed individual. If the 
mind in all other directions be up to the average, this talent 
tends to dwarf the other faculties by contrast, and often abso- 
lutely; the abnormally developed faculties apparently absorb- 
ing so much of nervous force that in the other directions the 
physical being is defective. A law of compensation seemingly 
exists in the make-up of many individuals — a talent in one 
direction is balanced by deficiency in another. In its extreme 
this is obvious in the "idiot savants," the "blind Toms," the 
precocious mathematicians, etc. 

When the psychic hypertrophy takes a direction involving 
the emotional faculties, as in the case of musicians, artists and 
poets, some striking moral deficiency is often evident, one of 
the directions in which failure might naturally be expected to 
occur. This latter class of geniuses, possibly the most numer- 
ous to which the term is popularly applied, are, to a certain 
extent, examples of degeneracy, and if* the term genius were 
limited to these it might be called a neurosis. This class of 
individuals is not limited to any one profession or trade, but 
is found in all the walks of life. Any man who is above the 



i ii I MEAD, FACE, JAWS AMD TEETH 191 

average in his line of business maj be justifiably term* 
genius. 

If en of genius, aa a role, are deficient both as t<> mental 
capacity and physically, Nisbet says that Lr<n i u -. Insanity, 
idiocy, scrofula, rickets, gout, consumption, and other mem 
bers of the neuropathic family of disorders, are but so many 
different expressions of a common evil an instability or 
want of equilibrium in the nervous system. From a mental 
standpoint nun of genius Buffer from epileptic mentality, 
melancholy, alcoholism, hallucinations and apathy, absence 
of moral sense, impulsive tendencies, doubting tenden* 
verbosit} or excessive taciturnity, imbecile vanity, excessive 
egotism. Physically they present stigmata like pointed car-. 
excessh e facial and head asymmet ry, irregularities of the jaws 
and teeth, left-handedness and arrest of development of the 
whole body. A few illustrations would not be out of place 
at this time. 

A lady of fifty-four comes from an old Btlassachussets 
family: has four Bisters insane. She is an author of three 
hook-, and write- for magazines and journals; Bhe is very 
bright. Some of her family have died insane and other- were 
drunkards. She had taken up writing in order that she might 
have an active brain, thus preventing her going insane like 
her sisters, as Bhe expressed it. She has arrest of develop- 
ment ^\' the superior maxilla. Her three sons are all very 
bright : one has tuberculosis; the other two are -mall for their 

age. All possess arrest of development of the jaw, with facial 
and cranial deformities. 

A forty-two-year-old journal editor, who i- one of the 
most brilliant writer- and talker- 1 have had the pleasure of 
meeting, quick-witted and very popular, one day he i- in the 
best of spirits and the next ha- the blues bo badly that his 
mood is felt by all witli whom he associates. He has marked 
asymmetry of the face, arrest of development of the upper 
jaw and slight protrusion of the lower jaw. 

Another editor, forty-eight year- of age, i- also very 
bright, very nervous, has strabismus, very large head, walks 

* Insanity of genius. 



192 ETIOLOGY OF OS8EOU8 DEFORMITIES OF 

unsteady and a little to the side; has a marked V-shaped jaw, 
with arrest of development. 

The president of one of the largest railroads in the coun- 
try is unusually smart as a business man; he has arrest of 
development of the upper jaw, with V-shaped arch and a 
saddle arch upon the lower jaw; marked asymmetry of the 
head and face. 

An expert machinist was given the most difficult work 
to perform in the shop; his ability was such that in one 
instance, he could take in the most difficult situations and 
bring them out successfully; he was quite an inventor, and had 
improved many of the machines used in the shop; his great- 
est fault was that he was a periodical drunkard, and frequently. 
w T hen needed the most would be away drinking. Later years, 
when he was given difficult pieces of work to perform and 
where brain work was required, it would seem to unbalance 
him; he would take liquor to brace him up, the result of 
which was that often before he was fairly under way with his 
work he would be lying drunk under his bench. He was 
irregularly built — the lower jaw was very small, the upper 
arrested, with V-shaped arch; asymmetry of the face, with 
very large, protruding forehead. A few years ago an expert 
mechanic could rarely be found in any department who could 
be depended upon. Most of them were very unsteady and 
periodical drunkards. 

The causes which underlie the development of genius are 
as interesting as the studv of the character itself. Indeed. I 
know of no more interesting study than that of tracing the 
history of great men from great-grandparents to great-grand- 
children. In every instance disease, as suggested by Nisbet 
(quoted in the beginning of this chapter), is found associated. 
Neuroses and degeneracy crop out in some form in each gen- 
eration, even more than in the average families that produce 
only mediocrities. The inheritance of genius seems to be 
perilous to the mental, moral and physical constitution, and 
these individuals w T ho are most envied, are often only the 
most unfortunate. 

In one hundred cases of editors, authors, newspaper men. 






I III III \h. I \( I . I \\\ - \N|) I I | | || 






professional men and expert mechanics, the following results 
w« iv obtained: 

Width outside first molar, 

Width outside first bicuspid, 

\\ i'ltli bet w een sea > 1 1 • 1 bicuspid, 
Heisrht of vault 



DEI ORMITIE8 O] I III .1 \ \\ 

V shape. 

Partial Y. 

Semi-V, 

Saddle, - 

Partial saddle, 

Semi-saddle, 

Marked deformities of the fa< 



•j. 1.. 

1.62 

1.05 

.51 



L2 
20 
6 
21 
L2 



CHAPTER XVI. 

IDIOCY. 

Dr. W. W. Ireland has defined idiocy as ''mental defi- 
ciency or extreme stupidity depending upon malnutrition or 
disease of the nerve centers, occurring before birth or before 
the evolution of the mental faculties in childhood." A defini- 
tion that seems more inclusive, and that more clearly describes 
the tissues of the body, is the one given by Dr. Shuttleworth: 
U A vice of the entire organism; an affection not only of the 
nervous system, but of the functions generally of organic 
life." Not a tissue of the body is exempt; the phenomena 
that check development of the brain-tissues will also interfere 
with proper development of the other tissues of the body. 

No part of the body has received the impress of disease so 
markedly as the osseous system, and yet, pathologists have 
given this part of the idiotic system but little attention. 
This osseous system seems to have been constructed regard- 
less of symmetry or uniformity. While in the normal indi- 
vidual the lateral halves are never uniform, in the feeble- 
minded the greatest symmetry prevails. This want of 
harmony is more apparent in the maxillary bones because of 
their peculiar formation and environment. The close prox- 
imity of the jaws, and their articulation, permit of irregu- 
larities being readily observed. At the beginning of my 
examinations I observed that other deformities than the V and 
saddle-shaped existed, all of which must be considered. I 
found both excessive and arrested development of the maxil- 
lary bones; arrest of the one, and excessive development of 
the other; protrusion of the upper or lower jaw; high or low 
vault; partial V and partial saddle-shapped arches; semi-V 
and semi-saddle-shaped arches; semi-V and semi-saddle- 
shaped on the same side, and small teeth. 

Of late years some American investigators have made 
examinations among the inmates of our institutions for idiots, 

194 



i ii i 111 \i>. i \< i . jaws \m • 1 1 i i ii L95 

and reported thai thej Pound about the same proportion <»t 
irregularities as maj be Been in ordinary praotioe. 

I believe myaeli warranted in the assertion that b much 
larger percentage of deformities of the teeth and jaws exists 
among a gh en num I ht of imbeciles, « U-nt and dumb and Mind 
than in the same Dumber of normal individuals, the various 
conditions being the result either of arrested development 
or excessn e growth. 

It is obvious that any condition of malnutrition, particu- 
larly if existing during the period of embryonal and infantile 
growth and development, which is sufficiently marked to 
oause perversion of growth in the complex nervous centers, 
must necessarily affect the tissues in general. Nerve-tissues 
have relatively greater vitality than the other tissues of the 
body, and every physician know- that the brain and spinal 
cord will often perforin their functions after the other struct- 
ures of the bojdv have been seriously impaired by disease. 

The varying opinions among scientific men, on either side 
of the Atlantic, led me to in\< -tigate the subject carefully. 
The examination- were made by myself and by able dentists 
in the following named institutions: 

A.S) lum for Idiots of the State of New York, at S\ racuse; 
Massachusetts School for Feeble-minded, at South Boston; 
Illinois Asylum for Feeble-minded Children, at Lincoln: 
Asylum for Idiots, Randall's Island. N. Y.: Minnesota 
Training-school for Idiots and Imbeciles, Faribault: Kansas 
State Asylum for Idiot- and Imbecile-. South Wintield: Cook 
County Insane Asylum. Dunning, 111.: Pennsylvania Institu- 
tion for Feeble-minded Children, at Elwyn. 

(Special reports may be found in the Transactions of the 
International Medical Congress, l s 77. and in the Annual, 
1888. 

The following tables show the total number of irregular- 
ities in each grade and Bex: 



19G ETIOLOGY OF OSSEOUS DEFORMITIES OF 

TOTAL DEFORMITIES IN THE JAWS.* 



6 




13 
g 
o 
2 




Protrusion 
Lower 
Jaw. 


Protrusion 
Upper 

Jaw. 


fcfl ri 
- > 

— 


V-Shaped 

Arch. 

Partial 
V-Shaped 
Arch. 


Saddle- 
Shaped 
Arch. 


— -5 

X 


1977 




1095 


152 


92 


159 


318 


129 236 


•.'07 


71 


Per cent. . . 


55.3 


7.(3 


4.6 


7.9 


16. 


6.5 , 11.9 


10.4 


3.5 



Out of 129 congenital cases, or those who were known to 
have become idiotic before the sixth year, 87 per cent pos- 
sessed marked deformities of the face and jaws. 

The above table shows that almost one-half of the whole 
number examined had irregularities of the jaws and teeth. 
The children examined were over twelve years of age. Under 
that age irregularities might be considered as of local origin, 
while constitutional and developmental irregularities do not 
appear until the eruption of the incisors and first permanent 
molars. As would be expected, the largest percentage of 
irregularities is found in the low-grade class; and it is seen 
that the normal classes in the high and middle grades vary only 
about 12 per cent; the middle grade showing the largest per- 
centage of normal jaws and teeth, the high grade the next, 
and the low grade the fewest number of normal cases. 

The mental capacity of the idiot can indicate in a general 
way only the abnormal condition of the osseous as well as 
muscular, venous and arterial systems of the individual: 
thus, a high-grade idiot might possess an atrophied condition 
of any of the tissues of the body, while a low-grade idiot 
might develop any or all of the tissues to an excessive degree, 
this depending, of course, upon the inclination and condition 
of the blood-supply. Thus the arterial and nervous systems 
might be atrophied on one side, lessening the supply of blood 
to that side or limb, and producing atrophy of the muscular 
and osseous tissues on that side. The opposite effect might 
be produced on the other side; a large amount of blood would 

* All tables show irregularities that are the result of small jaws. 



I ill BEAD, I \< i , JAWS w i» I i I I 11 I '.'7 

be carried naturally to the extremities of the other side, 
causing h\ pertrophy of tissue. 

It' these tissues of the body are so prone to take on abnor 
mal conditions, certainly the jaws must Buffer more or less. I 
bave observed three conditions that account for aearlj .-ill the 
irregularities of the jaws and teeth: excessive development, 
arrest of development, and inharmonious development of the 
maxillary bones. These abnormalities are developed with the 
osseous system, and maj be properly termed constitutional, 
or de\ elopmental. 

Wnen excessive development occurs in one jaw, and the 
oilier is normal, or arrested development ensues, (hen the 
teeth in the abnormally large jaw protrude. 

[f the cranium is large, the superior maxilla is usually 
Larger than normal. When the inferior maxilla is involved. 
the rami arc as likely to be enlarged as the body of the bone. 
Sometimes the rami and the body develop uniformly. When 
there is excessive development of a part or all of the bone, 
protrusion of the lower jaw and teeth takes place. I bave seen 
cases in which one-half of the superior and inferior maxilla'. 
as well as one-half of the cranium, was larger than the other. 
In these irregularities of the jaws, however, irregularity 
each set ^f teeth are seldom seen. While it is proper to 
-peak of these conditions as irregularities, yet they are so only 

as one jaw is related to the other. 

I have already shown, in a paper read before the Dental 
Section of the American Medical Association in l svv . that 
irregularities of the teeth, which I bave termed constitutional. 
prevail to a greater extent among the idiotic, deaf and dumb, 
and blind, than among an equal number of strong and well- 
developed persons; that not only is the brain-matter deficient 
in the feeble-minded, but that many cases are seen which 
-how that the osseous system is generally defective; and that 
when the bone-tissue is arrested in development from malnu- 
trition, the maxillary bones are affected. 

It is frequently the case that when idiocy appears in a 
family, other member- of the family are observed to be scrof- 
ulous, deaf. dumb, blind, or insane, showing that the condi- 



198 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

tions indicating neurotic tendencies have been transmitted 
through generations. 

In his work on "Insanity in Norway," Lud wig Dahl gives 
many instances in which the result of this tendency is deaf- 
ness, dumbness, or insanity., as often as idiocy. He says: 
"Acquired insanity and idiocy frequently appear side by side 
in the same family stock. Deaf -dumbness occurs frequently." 
He has traced the genealogies of a number of families, and 
has brought to light a number of interesting facts. In his 
genealogy of No. 3, the Ejvinds family have nine insane or 
idiotic, four deaf and dumb, and one epileptic. Other families 
showed a similar proportion of mentally and physically 
deformed persons.* 

In his work on "Idiocy and Imbecility," p. 528, Dr. Ire- 
land says: "Deafness frequently occurs in families where 
some of the other members are idiots.'' And again on page 
16: "The children of epileptics are frequently insane or 
idiotic or hysterical, and the descendants of an insane person 
are often epileptic, idiotic, or insane. Deaf-dumbness, chorea, 
locomotor ataxia, hysteria, and other disorders of the nervous 
system now and then occur in the descendants, apparently as 
the result of an inherent neurotic tendency in the family." 

In the report of the Commissioner on Idiocy appointed by 
the Legislature of Connecticut (see Report of Commissioners 
on Idiocy to the General Assembly of Connecticut, New 
Haven, 1856, p. 35), it was found that out of seventy cases 
of idiocy there were ten cases of idiotic parents, six insane 
persons, six insane relatives, eight epileptic parents or rela- 
tives, eight blind and two melancholic. 

Dr. Howe shows ("On the Causes of Idiocy," Edinburgh, 
1858, p. 35) that in seventeen families in Massachusetts the 
heads of which were blood-relations, there were born ninety- 
five children, of which forty-four were idiotic, twelve scrofu- 
lous and puny, one deaf, and one a dwarf. Morel and the 
school of investigation which he founded point out that the 
defective classes— i. «?., the congenital deaf mute, blind, luna- 

* Lombroso has called attention to deformities' of the jaws among the 
born criminals. 



Ml! IN \1'. I \« I . I \\N B \M» I I I I II 199 

tic, idiotic, criminals, and paupers are buds on the same 
tree of human degen< u ■■» 3 In dealing with the evidence 

ueracy tlu'\ cit*' defective teeth as one of the signs in 
most instances. These signs are atai ism <»r reversion t<> lower 
types of structure and function. Many mon could be 

given showing thai a relation exists between the deaf, dumb, 
blind, and insane, but it is evident thai the offspring of 
parents showing neurotic tendencies and symptoms are bud- 
jeel to these conditions. Medical men have commonly cL 
tied these lesions under the same head, and some specialists 
to so far as to classify tin* criminal and drunkard in this cate- 
gory. I have recently read an article from a French journal 
in which a left-handed person was also included. 

While specialists have generally concluded thai mosl oi 
these conditions are derived from a common neurotic ancestry, 
the only common feature i- a very low grade of cerebral 
development. In my investigations, concerning the osseous 
system in it- relation- to the irregularities of the jaw- and 
teeth. I have observed a lesion common to all these conditions. 
With this object in view I have made examination of the 
month- of all these classes including the criminal — which has 
been discussed in a previous chapter. I found great difficulty 
in enlisting sufficient interest on the part of superintendents of 
blind asylums to enable me to make proper examinations of 
the blind, their reason being that the sensitive nature of the 
patient- would not permit of their exhibiting the mouth 
tor examination. I have conducted a sufficient number of 
examination-, however, to make some estimate of the per- 
centage of deformities of the jaw- and teeth. 

Dr. A. Wilmarth. of the Pennsylvania Institution for 
Feeble-minded Children, says: " In six brains, the island of 
Keil wa- exposed through the defective development of the 
third frontal convolution: in four cases on two sides, in two 
on one -ide only. In eighteen brains -ix were found where 
the cerebrum failed to cover the cerebellum by from one- 
eighth to five-eighths of an inch." 

I could quote indefinitely from eminent authorities at home 
and abroad to show that not only art- the different structures 



200 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

of the brain of the average idiot atrophied and often entirely 
wanting, but that diminution of weight is the rule. Enough 
cases have been cited to give a general idea of the defects in 
anatomical structure. 

Having determined the constant relation of defective cer- 
ebral development to idiocy, it remains to be proven whether 
the defective condition is a special one affecting the brain 
only, or is an integral part of the generally defective or mal- 
development, or at least of a general tendency toward such 
perversions of growth. When we take into consideration the 
fact that the foetus is developed in two lateral halves, which 
may or may not develop harmoniously, and may or may not 
fuse together properly, it becomes logical to presume that 
any influence which tends to produce inharmony and asym- 
metry of growth in one part of the body — e.g., the brain — 
must necessarily tend to produce the same conditions in other 
portions of the foetal halves, providing such influence is not a 
purely local one. The causes of idiocy not being local, but 
general, the inference is obvious. It is astonishing to me 
that the superintendents of institutions for the feeble minded 
have made so little note of the asymmetrical relations of the 
two lateral halves of the body, in the cases under their care. 
Personally, I am of the opinion that harmony of members 
does not generally prevail in the anatomy of the idiot. In 
examining the inmates of various institutions, I was struck 
with the numerous examples of arrested development, hyper- 
troplrv and asymmetry of upper and lower extremities. 
These abnormal conditions accord with the types of cerebral 
maldevelopment already cited. 

In a paper, by Dr. G. E. Shuttleworth, England, presented 
before the International Health Exhibition. London, August 
2, 1844, upon "The Health and Physical Development of 
Idiots as Compared with Mentally Sound Children of the 
same Age," he says: "Many idiots are undoubtedly small at 
birth; not a few have been brought into the world prema- 
turely, but in nearly all imperfections of functions interfere 
with due nutrition and development, as the following table 
will demonstrate: 



I III 



\M> I I I I II 






1 \i-.i I -II- »\\ l\.. I III i;i I \ l l\ l MKAN STATU It I 



Of Th. » 

lint- 



\ M » W 1. 1 ' . 1 1 I 



il Population, and of rwelve Hundred and 
rlswood. Ri 







Hl.U 


,111. 






w EH 


,111. 




Btrtl 


oni] 


tDXOTfl \M> 


oun 


1KK.I- \M- 






I 1 M1..N. 


■III-. 




\i 


1 


M 


1' 


M 


1 


M 


1 




In. 


In. 


In. 


In. 












11.00 


ii».:.:. 


10.00 
















— 




n. v:. 




U.70 






7 




n. »:. 


14.00 












jj 




16.60 




15.25 




52.10 






'.i 










60.00 








10 


51.00 


51.05 


19.00 


19.00 


65.00 


62.90 






11 




53.10 


51.00 


5 1.00 


70.00 


68. l" 


64.50 




12 










77..MI 








13 










- 


- 




8 


1 l 




- 




:,•;.:,(» 






3 


88.00 


15 








58.00 


102.50 


L06.30 


94.50 


95.00 


L6 




61.75 






117.50 


L13.10 




L 02.00 


17 






62.50 






115.50 


1 10.00 




18 




62. 1 1 






1 12.50 


121.10 


1 16.00 


108.00 


19 


67.00 










- 




- 






- 


64.00 




1 15.00 




L21.50 


3 


-.'1 






64.25 




1 16.20 


L21.80 






. i. . 


. . . . 


3 


64.50 




l 17.50 












63.01 






I 18.70 


L24. 10 






24 




62.70 






150.00 


120.80 










62.02 


64.75 


:»'.'. 75 


151.20 


[20.00 




109.00 


10 












- 






10 




61.15 








1 18.60 






60 


- 










104.00 








•• It will be observed thai idiots are shorter than the gen 
era] population: at five years, by one inch; at ten year-, by 
two Inches; at fifteen years, by three inches; at twenty years, 
by throe inches. While, as regards weight male idiots are 
lighter than the general population — at eight year-, by four 
and one-half pounds; at ten years, l»\ six pounds; at fifteen 
year-, by eight pounds: at twenty years by twenty three and 
one-half pounds; the disparity being greater in the male than 
in the female sex. It appears that the relative rate of growth 
of the two sexes of idiot children follows the same rule as 
that of normal children, and is subject to the same variations 
at the age of puberty, for two years preceding which the 
growth of girls is in excess of that of boys." 



202 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

ABNORMALLY-SHAPED HEADS. 

If the mental capacity could, in all instances, be measured 
by the size and form of the head, many among the idiotic 
would rank high. The shape and size of the skull are indic- 
ative of the mind only in a general way, the feeble-minded 
being about equally divided between abnormally large and 
small heads. The measurement of the ordinary well-balanced 
head ranges from twenty to twenty-six inches in circum- 
ference, and that of the idiotic head from twelve to thirty- 
six inches. Opinions vary in regard to the average size 
of the microcephalic idiots, some claiming that all heads 
of sixteen inches and under come under this class, and 
others that thirteen inches in circumference is the aver- 
age microcephalic head; while on the other hand all heads 
which measure more than twenty-six inches in circum- 
ference would be considered either macrocephalic or hydro- 
cephalic. 

The extreme cases are comparatively few in the institu- 
tions. Out of six hundred inmates of the Pennsylvania 
Institution at Elwyn, which I examined with the assistance 
of the superintendent. Dr. I. N. Kerlin, and Dr. Wilmarth, I 
found but twenty-eight microcephalic, twenty-four macro- 
cephalic and three hydrocephalic cases. We shall find these 
extreme cases exceedingly interesting in the study of the 
etiology of irregularities of the teeth, and shall give special 
attention to their relations later. There is a certain size of 
the head below which an individual must be an idiot. Voisio 
says that "the proper exercise of the intellectual qualities is 
impossible with a head of from eleven to thirteen inches in 
circumference, and a measurement of eight to nine inches 
from the root of the nose to the posterior border of the occip- 
ital bone." Irregularities in the external surface of the 
cranium predominate in every idiotic head, and in such 
variety that no two heads are found alike. These conditions 
show a want of development of the brain. The brain sub- 
stance being the first to obtain its growth, the cranial bones 
are molded about it. and are. in a manner, supported by it 



I III III \l>. I \< I. I \W - \M> I I I I II 

until the Buturee have united. It the brain be ilow in devel 
oping and Bhaping, ossification of the sutures is retarded; 
should the brain, or parte of it. be retarded in growth, the 
oraniana nn « >uUi be either microcephalic or asymmetrical in its 
development. Again, inharmonious closure of sutures may 
also produce unilateral contractions of the bones of the head. 
I do not wish to oonvej the idea, however, thai asymmetry 
in the cranium i- always the result of malformation of brain- 
tissue, as a certain number of cases may result from arrested 
development or interruption in the growth of 1m>h<- tissue. 
'////•'/. I am well aware that perfectly symmetrical heads 
are rare in even normal individuals. The diagrams in pos- 
session ofour hatters tell a woful tale, not at all flattering t<> 
our racial self-conceit This retarded growth may result 
from constitutional disturbances acting unfavorably upon 
genera] nutrition, or from inflammatory condition- of the 
osteophyte membrane, which may take place in utero, thus 
prematurely closing the sutures. There i- no law governing 
the development of the brain and the closing of the cranial 
sutures. Those bones, the sutures of which close before the 
proper time, will he narrowed at the point of premature 
fusion. It is reasonable to expect that when hones prema- 
turely ossify at one part of the cranium, dilatation will take 
place directly opposite, as the brain grows in the direction 
of the Least resistance. This explains many peculiar deform- 
ities of the head. Again, if the majority of the sutures 
ossify prematurely, microcephalics may result It appears 
onable, also, to infer that the shape ^\' the basis cranii 
will he affected in a Bimilar manner by too early or too 
late ossification. These changes arc caused by improper 
nutrition of the hones and cartilage. A knowledge oi this 
fact gives ii- a clear conception of the relation which various 
genera] conditions bear to idiocy and imperfect development 
in general. The influences of such perversions of nutrition 
as are produced by syphilis, tuberculosis, struma and intem- 
perance over the ossification and growth of bone is a most 
patent one. The same influences which cause the shape of the 
base of the skull, and the contour of the face. ^\n not depend 



204 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

very largely upon the ossification of the sutures. When 
ossification of the cartilages occurs early, a shortening of 
the basis cranii may result. Especially is this the case 
when premature ossification occurs in connection with the 
sphenoid bone. The age when the basilar portion ossi- 
fies in a normal subject is from fifteen to twenty years. 
Early ossification naturally produces a shortening in the 
antero-posterior direction, and also serious deformities in 
the shape of the face, and an abnormal curvature at the 
base of the brain. The superior maxillary bones are attached 
to the bones of the head and face by eight articulations, 
and as the ossification of the sutures occurs at about the same 
time as the ossification of the sutures of the basis cranii, the 
same influences which affect the cranium must also affect the 
superior maxilla. These conditions may account for family 
features not presenting themselves until middle age. This 
is a strong argument in favor of postponing the operation of 
regulating teeth until the contour of the face has been perma- 
nently established. When there is inflammation of the mem- 
brane in utero (which is of common occurrence), the sutures 
ossify before or soon after birth, and as a result the base of 
the cranium will assume and remain in an undeveloped con- 
dition, causing the face to present an abnormal shape and 
size, which will broaden the face, throw the cheek bones out 
prominently, make the nose broad, and flat, and sunken, and 
extend the space between the eyes, giving as a whole a face 
void of expression. When the sutures at the base of the 
skull ossify normally the antero-posterior diameter is longer, 
the base of the cranium is more angular, the features sharper, 
with the eyes closely set, and a face full of expression. The 
sphenoid bone does not attain its full size until from the 
twenty-fifth to the thirtieth year of age. 

I am of the opinion that, when the bones at the basis 
cranii ossify before or shortly after birth, the superior maxilla 
and septum nasi assume a decidedly unnatural form. 

Dr. Oakley Coles, in his work upon "Deformities of the 
Mouth," ascribes the different deformities of the jaw to pre- 
mature ossification either of the sutures or the basis cranii. 



I III III \1>. I M I . I \\N v \\ |, | | | 1 1| 

Thus he nys that "the deformity known a- inter-maxillan 
prognathism is the result of a force operating oo the inter 
maxillary bone, Ruch force originating in the body of the 
sphenoid, and being transmitted by the intervening nasal 
septum.' 1 He say 8 also, page 13: "After carefully examining 
the works of various writers on the subject of microcephalic 
idiocy, there seems sufficient evidence to justify the belief 
thai premature ossification of the sutures is the rule in a 
majority of oases of microoephalus, :m<l we may there! 
assume, if are cannot absolutely conclude, that this influence 
operates powerfully in the production of the dental deformity 
known as the lambdoid jaw" (or V-shaped arch). 

While aa has already been observed, I believe thai pre- 
mature ossification of the sutures and basis cranii is followed 
by deformities of the jaw and septum nasi, I do not think 
that they hear to each other the relation of cause and effect. 
In this I beg leave to differ with Dr. Coles. It is unnecessary 

\patiate upon this Bubjecl here, as it will be the principal 
topic for discussion in another chapter. 

We ha\e considered above the morbid influences of vari- 
ous disorders in producing a vicious condition of the entire 
system called idiocy. It would be erroneous, however, to 
conclude that this isthe sole effect of these disorders, nor are 
excessive and arrested development limited to the crania 
of idiots, but they may be found in any portion of the 08S6OU8 
system, as appear- from perusing the literature referred to 
below. 

BIBLIOGRAPHY. 

1. Hutchinson. .1. Arrested Development of the Radius. 1 ore-arm 
and Hand." Tr. Path. Soc. London. 1865 •'.. xvii 228, 290. 

2. Leroy. • Arr-'t de Dereloppement de l'Avant-bras Gauche " 
Revue Photog. des Bop. de Paris. 1871, iii. v ' 

:'> Kodenstein. "Case of Arrested Development of both t ppei 
Extremities." Am. J. Obel . N V . 1876, riii • 

4. Shattuck. "Case of Arrested Development and Growth of the 
Right Upper Limb of Man." Tr. Path. Soc. Lond., 1881, \xxii 

5. Cayley, W. "Arrested Development of Fore-arm and Hand." Tr 
Ibid.. 1866-6, xvii. 430. 

6. Chipperfield. W. X. "Curious Arrestof Development of the Hand. 
Madras Monthly J. M. Soc. 1873, vii 409, pi. 



20f) ETIOLOGY OF OSSEOUS DEFORMITIES 

7. Doran, A. "A Case of Arrested Development of the Bones of both 
Fore-arms; Extreme Senile Changes in the Osseous Tissues." Tr. Path. 
Soc. Lond., 1876, xxvii. 314, 316. 

8. Dreyfous, F. "Arret de Developpement du Membre Superieur." 
Progres Med., 1878, vi. 483. 

9. Foucher. "Excessive Development of Left Arm and Leg." Bull. 
Soc. Anat. de Paris, 1850, xxx. 98, 108. 

10. Hill, A. "Case of Arrested Development in the Right Fore-arm 
of..." Brit. -Am. J. M. and Phys. Soc, Montreal, 1849, v. 119. 



CHAPTER XVII. 

\r i Kl tin l.. DEGENERA I l\ I.. SPIN LL and local 
REVERSIONAL TENDENCIES. 

While the conditions mentioned concern the present work 
imt remotely, they should not be lost Bight <>t\ Binoe thej are 
the outcome of neuroses and degeneracy, and may be asso 
dated with stigmata of degeneracy involving the osseous sya 
tern. Most of them are allied, and have been mentioned 
throughout this work; thua lymphoid degeneracy predispos- 
ing to phthisis and scrofula, tissue instability predisposing to 
ssive and arrested development of tissue have been fre- 
quently mentioned. 

Allied conditions, that have come to the notice of the 
author, may be mentioned here. A young man with a 
deformed upper jaw and face, like Fig. ."»•'». was married to a 
young lady with a deformed lower jaw, like Fig. 59. Both 
were neurotic- and degenerates. At the end of two years 
twin girls wcif horn. Another example: Father died at 
sixty two years of cancer; mother still living at seventy -four 
years. Oldest child, peculiar; second, epileptic; third and 
fourth twin-; in all. deformities of the head, face, jaws and 
teeth are present: all are hoy-. 

A young man. successful in business, was under my ojure 
while in Chicago. After removal o\' the tartar from tin- 
teeth profuse hemorrhage of the gums occurred. After six 
days the hemorrhage was controlled with great difficulty. He 
was confined to the house all the time. In the meantime I 
Learned from bis family physician that he had had two pro- 
fuse hemorrhages, presumably from the bladder. Two years 
after hi- experience with me his physician sent him to Cali- 
fornia; tuberculosis had set in and it was the only mean- of 
saving his life. He possessed a very marked V-shaped arch, 
with arrest of development of the hone- of the face. 

A sixteen-year-old girl, of marked neurotic temperament, 
delicate but handsome features, bright, and an excellent 

207 



208 KTIOLOGV OF OSSEOUS DEFORMITIES 

scholar, was taken ill, and is now being treated in a sani- 
tarium. Her uterus is undeveloped; she has never menstru- 
ated, and is in a precarious condition; jaws small, with 
V-shaped arch. 

Two very interesting cases of ameliac and polymeliac con- 
ditions have come to my notice. A gentleman, thirty-eight 
years of age, once in business in Chicago, possessed a face 
arrested in its development, having the appearance of a boy 
ten years of age; jaws small, with slight protrusion of the 
lower; he was minus arms; the hands were developed full 
size near the shoulders. The second case was that of a mem- 
ber of a family of the nobility of Spain. The stamp of degen- 
eracy was noticeable throughout his entire body. He was 
short in stature, with an excessively developed brain; the 
upper part of his head was very long compared with the 
lower. He holds a very responsible government position. 
The jaws were undeveloped, with V-shaped arch; the left hand 
was located near the elbow. 

A thirteen-year-old boy, of Irish descent, with high 
vault, V-shaped dental arch, arrest of superior maxillary 
bones; supernumerary little lingers upon left hand. 

A young man, twenty-six years of age, of German 
parentage; was born with club-feet. Father died of consump- 
tion; mother still living. This young man is an organist; 
plays in church on Sundays and gives music lessons during 
the week. He is a marked degenerate. The skin is thick, 
coarse and dry, giving him a very old appearance on account 
of its shriveled condition. Ears undeveloped; eyes small and 
sunken; excessive development of the cheek-bones; hair coarse 
and stiff; face arrested, and he possesses a partial V-shaped 
arch. Width outside first molar, 2; outside second bicuspid. 
1.75; width of vault, 1.60; height of vault, 58. One of the 
prominent features of degeneracy noticed in this case is the 
lack of hair upon the face. It has been the experience of the 
author that in nearly every case of club-feet, stigmata of 
degeneracy is stamped upon the head, face, jaws and teeth. 



CHAPTER Will. 

CONSANGUINITY OF PARENTS. 

Tin- effect of consanguinity of parents on the phj 
:m«l mental development of their offspring is that of the con 
oentration and reinforcement of hereditary tendencies. It' 
the heredity is altogether good and do Incompatible elements 
are introduced by either parent, occasional marriages of near 
relatives would not be productive of evil, and even L r <>"d 
might result from the intensification of desirable qualities, as 
we Bee it. to occur in the close breeding of fine stock. Hmh. 
the author of an elaborate work on "The Marriage of Near 
Kin." concludes that the mere fact of consanguinity of 
parents, irrespective of inheritance, in do way contra-indi- 
cates marriage. There are also some examples of isolated 

communities of a perfectly healthy Btock; tor example, the 
Pitcairn [slanders, referred to by Dr. Manning,* among 
whom idiocy, insanity and other similar degeneracies are 
absolutely wanting, notwithstanding constantly occurring 
intermarriage of nearly related individuals. These people 
live, it is true, under very simple and natural condi- 
tions, quite different from those of the densely populated 
countries or the centers of civilization. It is exceedingly 
doubtful, however, whether the vitality of a race is norm- 
all)' maintained under close breeding, in limited localities 
especially, even though physical signs of degeneracy are 
absent. Local intermarriages outside of all relationships, 
if followed nj) and practiced too continually, seem to 
have an unfavorable effect, as has been noticed in various 
communities. There seems to be a general law, or, at least, 
there is some reason to believe there is one. applying to 
nearly all form- of animal and vegetable life, that changes oi 
soil and seed are beneficial. 

There are localities in Europe where intermarriages pro- 

* Australia Medical < tazette, I : 



210 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

duce constantly individuals defective in constitution, mind, 
and limbs. " :: ' 

The incestuous practice of marrying within the near pro- 
pinquity had long existed in Spain, with its normal conse- 
quences, — dwarfing of the body, and mental degeneration. + 

Writers on lunacy attribute lunacy, or innate idiocy, so 
frequent among Scotch families, to the old national practice 
of never marrying out of their clan 4 The most degraded 
people in Portugal marry within themselves, and each gener- 
ation is more degraded, which is also true in other countries 
of Europe. 

In a county in South Carolina where the different families 
intermarried for many generations, the proportion of idiots 
and deformed is unprecedented. § Mr. Tylor j| has shown 
that among widely different races in the most distant quarters 
of the world marriages between relations — even between dis- 
tant relations — have been strictly forbidden. He is inclined 
to attribute this to the evil effects of consanguineous mar- 
riages having been observed -- 

Interbreeding among animals is much closer than with 
the human race. All breeders have testified to the deterio- 
ration which arises when too close breeding is carried out 
among animals. 

Consanguinity in itself counts for nothing, but acts from 
related organisms having like constitutions, and being 
exposed in most cases to similar conditions. Many physiol- 
ogists attribute the evil exclusively to the combination and 
consequent increase of morbid tendencies common to both 
parents; and that this is an active source of mischief there 
can be no doubt. 

The short-horn cattle offer the most striking case of close 
interbreeding. A high authority ** asserts that many more 
calves are born cripples from short-horns than from other and 

* Smith. 

+ Sir W. Scott. •• History of Napoleon Bonaparte." 

\ Percy Hunter. 

§ Nott and Gliddon. 

II " Early History of Man." 

^Darwin. 

**Mr. Wright. Journal of Royal Agricult. Soc. 



1 II I HIM). I \< I , .1 \W - \M> I I I I II 811 

lees oloserj interbred races of cattle. Even in an unen 
dosed country like Paraguay, where there oannol be such 
olose interbreeding, there is an occasional introduction of 
animals from distant localities, to prevent degeneration in 
size and diminution of fertility | 

In regard to deer, as observed in the parks of England, 
Mr. Shirley concludes that in -ohm- park-, where there has 
been no introduction of fresh blood, the constant breeding 
in-and-in is sure to tell to the disadvantage of the whole 
herd.:) 

The offspring of strong Bpaniels degenerate into weak and 
diminutive lap dogs, when bred in-and-in. In the case of 
pigs, long-continued and close interbreeding doe- not affect 
the external form or merit of the young; but with many of 

them the general constitution and mental powers were seri- 
ously affected; in some cases idiots were produced.* 

That consanguineous marriages have a very demoralizing 
effect upon posterity, is a well known fact to all scientists and 
physicians. The results are very marked in the nobility of 

Europe. The mental wrecks as well as the physical condi- 
tion i^ many of these royal heads arc illustration!? of inter- 
marriage among near relatives. It is claimed i>\ dentist- 
that excessive or arrested development and irregularities of 
the teeth are more common among royalty than among the 
masses. It is very common to find children horn of cousins 
and near relations in this country defective in body and limb. 
When the brain IS involved, we have two factors which 
assist in producing excessive or arrested development of the 
jaw-: First, direct inherited tendencies, such as a large or 
small jaw; and second, defective development due to neur- 
oses. These deformities are very marked among the 
Hebrews, with whom intermarriages are very common. 
Thus, in the Hebrew Orphan Asylum, New York City, only 
seventy-four per cent of the inmates had normal jaws.§ 

Consanguineous marriages not infrequently result in men- 

* Darwin. 

+ A/.ara, " Quadrupedes du Paraguay." 

t Mr. Seebright. 

| Mr. Wright. 



212 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

tal aberrations in the progeny. Dr. Howe states that in 
seventeen families, the heads of which were related by blood 
and intermarriage, the result was fearful. Most of the 
parents were intemperate or scrofulous, and some combined 
both evils; so that it must be admitted there were other causes 
besides consanguinity to increase the probability of infirm 
offspring. There were born in these families ninety-five 
children, of whom forty -four were idiots: twelve others were 
scrofulous and puny, one was deaf and one was a dwarf. In 
some of the families all the children were either idiotic or 
very scrofulous and puny. In one family of eight children 
five were idiotic. The commissioners of idiocy in Connecti- 
cut found in one hundred and sixty cases of idiocy, twenty 
which apparently resulted from consanguineous marriages. 
Of these, twelve were children of first cousins, three of sec- 
ond cousins, one of third, and four of distant relations. Dr. 
Langdon Down found that out of seven hundred and fifty- 
three male idiots thirty-three were the offspring of first 
cousins, three cases of second cousins, and four of third 
cousins, — in all forty cases out of seven hundred and fifty- 
three, or rather more than five per cent. Of the two hundred 
and ninety-five females, thirteen were the children of first 
cousins, three of second cousins, and four of third cousins, — 
in all twenty among two hundred and ninety-five, or a little 
less than seven per cent. His researches show that in Eng- 
land at least every fourteenth idiot is the child of cousins. 
The majority of cases of idiocy appear at birth, and many 
such may be traced to habits or tendencies of ancestors. 
Often it is difficult to determine in what generation the germs 
of the disease were planted. Ludwig Dahl, of Norway, in 
his work on 4i Insanity," shows, by means of a genealogical 
tree, how an apparently healthy couple may have children, 
grandchildren and great-grandchildren affected with idiocy 
and insanity. In reviewing the field of possible causes of 
idiocy, I am greatly impressed by the apparent influence of 
consanguineous marriages. Dr. S. M. Bemis, of New 
Orleans, has found, through his examination of statistics, 
supplied by a number of physicians, that among two thou- 






i ill HEAD, FACE, JAWS AND TEETH 218 

Band -••vcii hundred and Beventj * - i i_r 1 1 1 children, the fruit 
intermarriage of first cousins, seven hundred and ninety 
three were normal; one hundred and seventeen deal and 
dumb; sixty three blind; two hundred and thirty-one id o 
twenty four insane; forty-four epileptic; one hundred and 
eighty nine scrofulous; fiftj three deformed; six hundred 
and thin \ -»'\ en died early. 

With the larger percentage of neurotics and degenerates 
'm (Hii- civilization, the chances of <'\il from consanguineous 
marriages are greatly increased, and, inasmuch as prudential 
considerations are Largely neglected in such matter-, t h«- 
laws of Borne of the states of the Union prohibiting marriage 
between first cousins are not unjustifiable. 



CHAPTER XIX. 

INTEMPERANCE. 

There is a wide variance of opinion among medical men 
regarding the probable influence of intemperance of parents 
in the production of idiocy and allied conditions in their off- 
spring. Dr. Langdon Down is emphatic in his opinion that 
drunkenness at the time of conception is liable to produce 
serious results upon the brain of the child. Ludwig Dahl 
believes that the abuse of brandy in both father and mother 
is one cause of the large number of idiots in Norway. Demme 
reports that 64 per cent of the idiots received during seven 
years in the Bern asylum had drunken parents — fathers 
mainly. On the other hand, Dr. C. T. Wilbur, of the Illinois 
State Asylum for Idiots, states that in three hundred and sixty- 
five idiotic patients eight only claim drunken parents. Dr. 
Graham, superintendent at Earlswood, England, also states 
that he found among eight hundred inmates of that institution 
but six cases of idiocy which could be attributed to intemper- 
ance of parents. Whether or not drunkenness is responsible for 
idiocy we cannot decide, but we know positively that intem- 
perate habits are transmitted from generation to generation, 
each series of progeny in the line of descent showing a lower 
grade of intellect. As further illustration I cannot do better 
than quote Dr. Shuttle worth: 

''Considering the intimate and prolonged dependence of 
the child upon the mother during gestation and nursing, 
one would suppose a priori that maternal rather than 
paternal drunkenness would count most in the production of 
idiocy. In the cases which I have tabulated, drunken fath- 
ers preponderate in a majority of thirteen to four. Possibly 
the mental anxiety entailed upon the wife by a drunken hus- 
band during the impressionable period of pregnancy may in 
part explain the discrepancy. Whatever the direct effect of 
drink upon the foetus in utero, there is little doubt that such 
nursing as a child is likely to obtain from a drunken mother 

214 



I ill HEAD, FACT, JAWS AND TEETH 210 

will intensify an\ predisposition to mental defect. The bane 
ful practice of giving infants alcoholic drinks seems t<> pre 
vail to a great extent in Sweden and Norway, Such | » i; t < - 

tire iiwiv in pari account for the extensive prevalence of 
idiocy and juvenile insanity in Scandinavia, as described by 
Ludwig Dahl." 

The Bmallness of the figures reported by Drs. Wilbur and 
Graham may, perhaps, be reasonably accounted for by the 
presumption that the facta were Dot fully reported. It is 
usual in public institutions to take <>nl\ assigned causes in 
making out statistics, and it is very commonly the case that 
discreditable causes are n«>t given as such in commitment 
papers, etc. Family pride, and on the part of the children, 
the dislike to state facts discreditable to parent-, are often the 
causes of the suppression of important data. The reason of 
the preponderance of drunken father- over drunken mothers 
is easily accounted for, when we take into consideration the 
greater tendency to intemperance in the male sex. It is 
doubtful whether there could he found in this country as 
large a proportion of maternal drunkeness as Dr. Shuttle- 
worth reports in ( Sreat Britain. 

Idiocy is only one. and that, probably, not the most fre- 
quent evil result in the offspring from parental intemperance. 
Insanity, criminality of the moral insanity type, vagabond 
tendencies, and. perhaps, more than any other one thing, 
epilepsy, may be traced hack to this source. Dr. Hypolite 
Martin, m investigating the subject of epilepsy in children in 
the Salpitriere, in l s 77. found parental intemperance in 46 
per cent and I am informed by one who has had fair oppor- 
tunities ^i observation, that a very large proportion of the 
idiopathic cases, oi the epileptic inmate- of the insane 
asylums have this antecedent. The obtainable figures are, 
moreover, rather under the truth, in all probability, owing 
to the difficulty already mentioned of obtaining correct 
reports as to discreditable facts. The gentleman gives, as 
instance, that he has known parental intemperance denied 
absolutely in the history, while a drunken parent brought 
his child to the institution. It is probable, therefore, that 



216 



ETIOLOGY OK OSSEOUS DEFORMITIES OF 



full and correct data would give a very high proportion of 
intemperate antecedents of parents in idiocy, insanity, epi- 
lepsy, and generally in other neurotic and degenerative con- 
ditions. If we take into account also the poverty, anxiety, 
disease, and all the unfavorable conditions due to intemper- 
ance, the percentage will be still further increased. The 
habit of giving alcoholic drinks to infants, alluded to by Dr. 
Shuttleworth, is not at all uncommon amongst the classes 
who use these stimulants freely, and with this should be men- 
tioned also the practice of giving neurotic stimulants, such 
as strong tea and coffee, to very young children, which is very 
common in the poorer classes of our large cities. Tobacco, 
also, is frequently given to children, and has its share in the 
production of degeneracy. The habit of cigarette smoking 
by young boys, so much deprecated of late, seems to bear 
abundant evil fruit in the production of insanity and other 
nervous derangements, and prepares the way for future 
degeneration in the offspring of its habitues. It is a singular 
fact that nearly all of the inebriates in the sanitariums and 
asylums are habitual tobacco users in some form or other. 
This would indicate that the persons so using it had acquired 
a very nervous condition, and that the stimulant was uncon- 
sciously used to tone up a nervous system. An offspring of 
such a parent could not expect to inherit a strong, healthy 
constitution. 

Deformities of the jaws among this class Avere found to 
stand second to those of the prostitute in the list of large 
percentages. This could hardly be otherwise when we con- 
sider the fact that this class, like the prostitute, is a marked 
neurotic and degenerate one. with all the vices combined. 

TABLE OF DEFORMITIES OF THE JAWS OF THE INEBRIATES/' 



6 


c 

In 

o 




— > 


V-Shaped 

Arch. 


Partial 

V-Shaped 
Arch 


Semi- 
V Shaped 

Arch. 


Saddle 

Arch. 


Partial 
Saddle 
Arch. 


Semi- 
Saddle 
Arch. 


514 




G.4 


59.5 


1.5 


24.4 


0.3 


9.3 


13.2 


7.7 



* The examination of inebriates was made in The Keeley Institute. Dwight, 
III.; The Inebriates' Home, Ft. Hamilton, X. S.: Washington Home. Chicago. 
Washington Home. Boston, and Dr. brother's Institute. Hartford, Conn. 






NIK. Ill VI', I \« I . JAWfi \M> ! I I I II 

It ail tli< i deformities of 1 1 1 • - head and face bad d 
included there would have been fulrj 95 to 9fi per oenl <>t' 
deformities among tin- class of individuals. Many of these 
unfortunates were geniuses or unusually bright people, Includ 

Insr doctors, iudoes, lawyers, ministers, railroad officials and 

— ) — 

business men. 



CHAPTER XX. 

MATERNAL IMPRESSIONS. 

The popular beliefs in regard to the effect of maternal 
impressions on the offspring are not shared to any very great 
extent by the medical profession — that is, in their extreme 
acceptation. There is, of course, no question as to the possi- 
ble influences of the maternal conditions during pregnancy, 
but the direct action of maternal impressions is exceed- 
ingly dubious. If the popular notion in the regard were 
based on fact, it would be extremely unfortunate, since no 
pregnant woman can be assured against mental and emo- 
tional shocks such as those to which the production of vari- 
ous monstrosities is attributed. There is, however, a very 
great possibility that cannot be disregarded by physicians, 
that in many cases serious damage may be done to the unborn 
child by the occurrence of such accidents, which may reveal 
itself in its post-natal development under some one or more of 
infinitely variable forms of physical and psychical degeneracy. 
When we consider that the mothers in these cases are very 
likely themselves to have some nervous or mental instability, 
this is still more a matter for consideration. The physical 
and mental conditions of either parent at the time of concep- 
tion may have their influence, though this is not often readily 
determined. Something has already been said that bears 
on this point when speaking of the effects of intemperance of 
parents — especially paternal intemperance — on the offspring. 

It is unquestionably a fact that a fright to a mother dur- 
ing pregnancy is occasionally a cause of idiocy in children. 
Women instinctively shrink from anything which would pro- 
duce a shock or special mental impression during the period 
of gestation, fearing for both the mental and physical welfare 
of the child. Strange to say, the same maternal instinct pre- 
vails with the brute creation. 

Dr. G. H. Fisher has written a very complete history of 
the ''Literature, Classification, and Description of Human 

218 






1 111 in m>. f \> i . i \w v wi) 1 1 i i ii 219 

and Brute Monstrosities," including the so-called parasitic 
monster known as "Fetua in Fcetiu," and the various super 
numerary formations of parts and organs which are familiar 
to medical men. Manx interesting cases are fgiven i>\ this 
author, including deformities of the upper and lower extremi 
ties and interna] organs. He Bhowa that the lower animala 
in.iv become insane, and that heredity and pre-natal shocks 
have much to do in producing these conditions. 

[nnumerable cases of pre-natal shocks producing idiocy, 
where the parents were both apparently healthy, are on 
record. In one case the news of the Loss of the husband al 
sea had the effect of impairing the intellect of the unborn 
child. Again, the same result occurred in another case a 
result of fright occasioned by a team of horses running away 
with the mother when well along in ntero-gestation. Baron 
Percy, a French military Burgeon, observed that out of ninety- 
two children whose mothers had been exposed to the terrors 
of a tremendous cannonade at the Biege of Landau, in L793, 
Bixteen died at the instant of birth: thirty-three Languished 
from eightto ten month-, and then died before the afire of five 

a 

years: and two were horn with numerous fractures of the 
hone- of the b'mbs. 

Just how impressions of the mother affect the foetus is 
difficult to describe, but that they do produce marked effect 
is illustrated in the following cases : A man and wife. Living 

upon a farm, had twelve children. The country was high, 
rolling ground, air perfectly pure, and one of the healthiest 
districts in the state. The death rate at that time was only 
about three per L,000. The children, six boys and 
girls, were born just about two years apart The surround- 
ings and conditions of life, as far as lam able to ascertain, 
were the same in the entire twenty-four years; no taint of 
any kind in the family a- far as I could learn. All the chil- 
dren grew up to he men and women. The fifth, a boy, died 
at the age of twenty-two years. He possessed a very -mall, 
undeveloped chest, arrest of development of the bones of the 
face and nose, long sleo der nose, total collapse of the outer 

♦Trans. X. Y. State Med. Soc.. 1865-68. 



220 ETIOLOGY OF OSSEOUS DEFORMITIES 

walls, and chronic nasal catarrh, which he possessed from 
birth; death was the result of consumption due to catarrh. The 
seventh, a girl of eighteen, died of consumption, contracted 
by contagion while nursing a sick cousin who died of the dis- 
ease. The youngest, a man now twenty -four years of age, 
has head and face excessively developed forward, as illustrated 
in Fig. 88; a decidedly V-shaped upper jaw and arrest of 
dental arch of the lower jaw; chest contracted; only one 
testicle passed into the scrotum, a condition inherited from 
his father. Has taken up a profession, and indoor life is not 
conducive to health; he is therefore delicate. The man is as 
bright if not brighter than any of his brothers or sisters. 
Why should two children, the fifth and last, be constructed 
so differently when all the conditions are the same ? There is 
only one answer — either worry, starvation, or physical 
debility. The author could select many cases illustrating 
this peculiar uterine development and education, but this one 
is sufficient to show its peculiarity. 



CHAPTER XXI. 

CITY VERSUS I OUNTRY LIFE 

It is a well known and recognized fact thai the people of 
theoitj are of lower stature, lighter limb and are more bus- 
oeptible to the ravages of disease. That mortality la 
and longevity less in the city, as compared with the country, 
[a too well understood to need much discussion. ' : The mor 
talitv ia two and one half times greater in the eitj than Id the 
countrj 

It has been said thai a family Living continuously in Lon- 
don, and intermarrying with families who have resided in 
London constantly, would die out in three generations. 
Again, a family Living in London for two hundred year- and 
marrying among people nol Less old, would become extinct 
within the two hundred years. | 

[f all the people of tin- world lived in cities the human 
race would become extinct in two and one half centuries; § in 
all probability the mortality would be greater the Larger the 
cities. It has been shown thai women attain greater Longevity 
in the city than in the country. In the country the life of 
women is monotonous; the brain is used very little and very 

little recreation LS taken: the hour- of work are very Long, 

from early morning until late at night; thus insufficient Bleep 
does not give the body time to recuperate. Longevity oi 
men i- lessened by residence in the city, no doubt due to 
closer confinement and more hazardous occupations. \\ e also 
find that dissipation and intemperance are increased. 

The greater mortality of cities is due to foul air, unsan- 
itary conditions and intemperance. Among these may be 
included irregular hours, want of exercise, unhealthful and 
more hazardous occupations, undue excitement of the nervous 

• Mr. Stockton-Hough. "Relative Influence oi City and Country Life." 

• Professor Donaldson; Sussmilch; Drs. Jarvis, Farr, Berg, Berz, and many 
others. 

; Mr. James Cantile. J. Nfilner Fothergill. 
| "Relative Influence of city and Country Life." 
Dr. Morgan. 

821 



222 ETIOLOGY OF 068EOtJ8 DEFORMITIES OF 

system, less pure water, unwholesome food, unhealthful dress 
and an overcrowded condition of the people, especially in 
tenement-houses and flats. We must not forget the fact that 
country people are continually thronging to the city, and by 
intermarriage with city people infusing new blood and new 
life into them. This fact no doubt adds much to lessen the 
mortality of the city. 

That the quantity of oxygen is sensibly diminished in the 
air of large cities, even in the open street, cannot be denied. * 
The large number of people congregated in a small area, 
together with the artificial means, if we may so call it, of 
using up oxygen by means of increased fires and light, would 
naturally reduce the oxygen in the air and increase the car- 
bon dioxide; add to this the fact that vegetation is utterly 
wanting, which is the chief factor in using up the superfluous 
carbon dioxide and supplying us with free oxygen. The 
amount of sunlight is also diminished. Now, when these two 
conditions exist, we would naturally expect to find lessened 
physical development. * l Light is the very life-blood of nature, 
without which everything in nature would perish utterly." f 
When blood passing from the lungs, where it does not obtain 
a supply of oxygen, carries to the brain and other tissues 
and organs carbon dioxide, the consequence of an arrest in 
the changes necessary to life and growth would result. % 
The effects of carbon dioxide poisoning are far-reaching. 
Through the brain it affects all tissues of the body. Lack of 
pure air and of bracing air creates a distaste for exercise; 
active exercise, but exercise not carried to excess, keeps up 
the equilibrium between waste and repair. § Another cause 
of the lack of exercise is -the facility with which different 
parts of the city may be easily reached by means of street- 
cars, cabs, omnibuses, etc. Then, also, we find that people in 
the city are more hampered by dress than those in the 
country, which is a cause for deficiency of exercise. We also 
find in the city a lack of suitable places for exercise. Now, 

* Professor Wilson. 

fSir David Brewster. 

+ Dr. Bell. '"Perils of School-room." 

^ Dr. Darbishire, "Recreation." 



liii READ, I \i i . FAWfi \M> i i i i 11 

since deficiency of exercise exists among citj people, «ve 
would nat m all \ expect to fiii* 1 deficient 3 of phj sioal develop 
mem. which is the case. The city born criminal is found t<> 
be inferior, physically, to the country bred. Biologically, 
man is b fresh air animal; | exercise in fresh air increases t In- 
activity of all organs of the body. Muscular activity demands 
activity «»t' the circulation t»> keep up the equilibrium of waste 
and repair. Muscular activity creates increased activity <d" 
all the eliminating organs, to rid the body of the products of 
the disintegration of molecular activity of muscles. The 
circulation being increased, the respiratory system is 
inoreased to inert the greater demands for oxygen. This 
brings about r \ igorous action of all the organs of the body, 
and, being a physiological process, if kept within physiolog 
ieal bounds no harm but good can result This course of 
living was carried out in the patriarchal age. There was 
moderate activity of all the organs of the body; there was 
repose to the nervous -\ stem; the appetite was normal, diges 
tion was healthy, and there was exemption from local causes 
of disease. No other causes of death occurred, save those 
arising from accidents and old age.} 

The converse of muscular activity producing well-devel 
oped physical condition must be true: i. 0., lack of exercise 
will cause Lessened physical development^ Animal- which 
for generations hack have taken little exercise have their 
lungs of -mailer Bize, which moderate- the form of the bony 
fabric of the chest, and the latter affects the form of the body 
a- a whole. With onr anciently-domesticated birds, where 
wine> have been little used, their size i- somewhat dimin- 
ished, and we find the sternum, coracoids and scapulae modi- 
tied in form. The decrease in the amount of exercise must 
cause a decrease in the appetite or create an abnormal appe- 
tite. The country-bred person therefore eat- pa-trie-, meat- 
pie- and hearty food, and has no difficulty in digesting them. 

»Dr. Beddoe. 

* Dr. Darbishire, ''Recreation." 

t Dr. Smith. " Limitations and Modifying Conditions of Human Lon- 
gevity." 

8 HerbeH Spencer. ••Physical Education." 
Mr. Darwin. 



224 KTIOLOGY OF OSSEOUS deformities of 

He has plenty of fresh milk, butter and vegetables; the 
milk, from the presence of the phosphate salts, heightens 
stature. * The city person cannot eat meat-pies and pastries 
at all, therefore he rejects them.f He finds that he can eat 
meat; as a consequence he partakes largely of a flesh diet, 
but his exercise is hardly sufficient to digest this. If he is 
not strong enough it passes through the alimentary canal 
undigested, partly decomposed, causing in some cases only 
abdominal tenderness; in other cases other evils.:}: If the 
digestion is strong enough to digest this food, additional 
work is thrown upon the liver and kidney. Uric acid is one 
of the products of the oxidation of flesh food.§ It is excreted 
by the kidneys, and sets up interstitial nephritis. Uric acid 
is also a cause of gout and lithsemia. 

Again, the city-bred person rejects all fats, which are 
necessary to healthy tissue; he rejects them because the 
greater part of his life is spent in an overheated room. Peo- 
ple who live among the Esquimaux soon acquire a relish for 
whale-blubber and all the fats and oil they can obtain. || This 
lessened use of fats, and diminished oxygen and sunlight, are 
the great causes of pulmonary consumption, which claims 
twenty-five per cent greater mortality in the city than in the 
country.""" Deficiency of breast-milk in mothers is a cause of 
stunted growth, * and want of good cow's milk is also a 
cause. Early and copious use of alcohol, and intemperance; 
want of opportunity and stimulus for the development of 
their physical powers by young persons in town, the earlier 
occurrence of puberty, JJ and greater frequency of youthful 
profligacy* are among the etiological factors of stunted 
growth. The crowding of people in tenements, where 
breathing of effluvia over and over occurs, also the crowding 
together of pauper population in cellars and underground 
rooms, must act as fruitful causes of deformities and disease. 

* Beddoe. 

+ J. Milner Fothergill. 

+ Dr. C. Chambers. " Dietetics." 

§ Fothergill: Dr. Chambers. 
Darwin. 
** Professor Donaldson. 
::Quetelet. "On Man." 



I I! I II I \l '. I \( I . I \\\ «. \\ I » I I I | || 

These houses are often erected on land made of swe< \ 
Btreets, where the Btreets are narrow and filthy. The sewer 
age is often inadequate to the demands, and the contents oi 
cesspools surcharge the porous earth. Wherever such 

conditions arc met with, Bickness must prevail, and thus all 
physiological processes, growth, and development \\ ill become 
perverted. 

In the city the constant excitement hastens the develop 
mm i of the nen ous system, which is the center of the nerve 
force Bupplying all the organs of the body. Unrhythmical, 
harsh, and jarring Bounds cause molecular disturbance of the 
Bystem. Specialization must have a baneful effect upon the 
body. The exclusive concentration of mind and muscle to 
one mode oi action Is both negatively and positively per- 
nicious, and more bo when accompanied by bad air in over- 
heated and ill-ventilated apartments. f Close confinement 
in school-rooms, together with competition, which must 
necessarily follow from our public school Bystem, must work 
ravages upon the Bystem, especially the nervous Bystem, of 
the children, united as it is with the pernicious conditions 
existing.:] In addition to the school duties, the city child 
has usually to pursue the study of music, painting, and the 
like, from all of which the country child is free. All these 
must necessarily produce an artificial condition of life, under 
which condition a degenerated physique is found, and more 
deaths must occur. § The child is ill-equipped to meet the 
demands of physical life, and therefore it cannot meet the 
demand- madeupon the brain and nervous Bystem. 

Population tends to concentrate more and more in dense 
masses. In some of our older states from fifty to seventy- 
five per cent of the whole population live in cities number- 
ing eight thousand or more. Registration report- of Massa 
chusetts, which have now been published for forty-seven 
years, show that in thirty years— from 1850 to 1880— the 



•Dr. Clendenin, "General Causes ol Carl 

Ffeitler. 

+ Dr. Beard. "American Nervousness.' 1 
: ^ir John Sinclair. 

jj Dr. Price. 



226 ETIOLOGY OF OSSEOUS DEFORMITIES 

average age of all persons who died in Suffolk, in which Bos- 
ton is included, was twenty-three and one-third years. The 
corresponding age in Barnstable" county, also on the sea- 
board, was thirty-seven. In Franklin county, an inland rural 
county, it was thirty-eight and one-half years, while in the 
island county of Nantucket it was forty-six and fifteen one- 
hundredth years, nearly double that in Suffolk county, thus 
showing that the uniform higher death-rate is greater in 
densely-populated counties. * 

In the town of Sharon, Norfolk county, Mass., which is 
the highest point of land in the eastern part of Massachusetts, 
and has a population of about thirteen hundred, the average 
longevity is sixty -four years. 

* President C. W. Eliot, '• Family Stocks in Democracy." 



CHAPTER XXII. 

( I >NSTITU1 EONAL LESH >NS. 

The results of constitutional diseases are more marked in 
the osseous system than any other part oi t h»- human body. 
I> Militating acute diseases fevers, the exanthemata, etc.) in 
children are sometimes followed by sudden overgrowth of 
hone, which is quite noticeable. This process affecting the 
'ii- system may accounl for certain proportions of those 
cases ^\ measles, pneumonia and other diseases which arc 
followed by dental irregularities and maxillary deformil 
In some oases, however, the process is a low grade of inflam- 
mation, which is followed by atrophy of the jaw instead of 
hypertrophy or hyperplasia. The special predilection of these 
processes for the superior maxilla is. on account of it- liberal 
blood and lymphatic supply, and the continuity of such cavi- 
ties as the antrum and n&sal fossw, which, in many cases, 
contribute their quota of irritation. 

The question of diathesis enter- Largely into the etiology 
of maxillary and dental deformities. The physical charac- 
teristic- of strumous children demonstrate this fact quite 
forcibly. The description of this diathesis given by Fother- 
gill i- decidedly apt in this connection: " The diathesis ha- an 
imperfectly developed osseous system ;i- one of its character- 
istics. The hone- are small, the shafts -lender, the epiphyses 
enlarged; the hands are often unshapely from this osseous 
defect; the thorax i- -mall; the forehead is high and promi- 
nent; the jaw is small, and the teeth crowded and carious.' 1 

Persons of a nervous diathesis have small jaw-. Consti- 
tutional diseases, such a- the exanthemata, syphili- and phthi- 
sis may affect the jaw- in common with the other bony struc- 
tures, and a- the teeth i\o not vary much in -i/.e in different 
subjects, a relatively -mall jaw results in such cases. Dr. 
Florence Hunt informs me that the majority of the Swedish 
and Norwegian patients of the Cook County [nsane Asylum 
are affected with scrofula and other constitutional disc 



22S ETIOLOGY OF OSSEOUS DEFORMITIES OF 

and that post-mortems reveal soft and undeveloped epiphyses 
not unlike cartilages. Writers on surgery have assigned as 
some of the causes of non-union of fractures of bones, the 
so-called scrofulous condition, the existence of any of the 
exanthemata, or the debility arising from them, and syphilis. - 
The arrest of development of the entire organism following 
cerebro-spinal meningitis is well known to everyone. 

Pathologists have maintained that the regenerative pro- 
cess in all tissues is below par in constitutional diseases; that 
is, that wounds do not heal so readily in a person the subject 
of constitutional disease. The development of tissue from an 
embryonal type to mature tissue is identical with the regener- 
ative processf in the healing of wounds, or, as Senn;}; calls it, 
the vegetative process. Therefore, the same causes that 
retard the one process must retard the other. Following out 
the theory of Metschnikoff and his followers, we must con- 
clude that the energy of the organism is expended in repelling 
the advances and barring the further progress of the micro- 
organisms that are the causes of these constitutional diseases. 
In consequence of this continuous warfare between the cells 
and microbes the tissue cells, that are regenerated, do not 
increase the size of the organ as in normal development. 
That these constitutional diseases do cause an arrest of devel- 
opment in children is well known to every observant parent. 
Sometimes this arrest of development will be permanent at 
the time of the disease, but more often the growth of the 
child is stopped for one or more years, and frequently devel- 
opment will not go on until the child is taken to another 
climate. The effect upon the jaws and teeth is very marked, 
especially is this the case in the upper jaw. When arrest of 
development of the teeth takes place pits and furrows are 
found upon the enamel. Every specialist of experience is 
able to determine, by these pits and furrows, the exact year 
when arrest of development took place. The well-known 
Hutchinson's teeth, familiar to every physician and dentist, 
are well-marked illustrations of this fact. 

*Erichsen. ••Science and Art of Surgery." Wyeth, "Surgery." 

t Hamilton. "Pathology." 

\ Senn. "Principles of Surgery." 



I ill BEAD, FACE, JAWS AND TEETH 

The eruptive fevers in children have a tendency to leave 
the system io i neurotic and degenerative condition. We 
frequently find children, who, before their illness were 
apparently health] and well, after having these diseases are 
sickly and ailing for years, and occasionally they never wholly 
'i Midi conditions affect the eyes and ears, and not 
infrequently the organsof speech. The eyes remain weak, 
and occasional I3 the patient becomes nearly or quite blind. 
Thehearing is frequently permanently impaired; occasionally 
also the nerve centers, which preside over the development of 
the osseous system, and then- is a general arrest of develop- 
ment of the whole body. Such persons not infrequently 
remain sickly through life, while occasionally they recover 
their health, though the body ceases to develop its normal 
size. A few illustrations will not be out of place here. 

A young girl, now fifteen year- of age, born of apparently 

healthy parent-, had a very severe attack of scarlet fever at 
the age of seven year-. Ai Test of development of the upper 
jaw. and a Y-shaped arch developed; -he has been near- 
Bighted ever since and now has very weak eyes; -he stepped 
growing for three \car-: she was taken to California and 
Europe, as the result of which she is now getting her full 
growth. 

A boy had pneumonia at the age of four. He i- now 
nine; arrest of development of the bom- of the face i- very 
marked; he is not old enough yet to decide what effect it 
will have upon the jaws and teeth; he ha- -topped growing 
and is now very small for his age. 

A young lady, now twenty-two years of age, had BCarlel 
fever at the age of seven, a- a result of which -he became 
(!, '>-'t' and dumb; the hone- of the face and jaws arc unde- 
veloped, and possesses a marked V shaped arch; pits and 
grooves upon her teeth denote the age when -he had the 
disease; -he has developed into a very handsome, full-grown 
woman. 

A lady, forty years of aire, had scarlet fever at three 
years. Her eyes became inflamed, and she lost their sight 
for twenty-four years, when they gradually grew better, 



230 ETIOLOGY OF OSSEOUS DEFORMITIES 

owing to chancre of climate; she can now see fairly well. 
However, when her health became poor her eyes still troubled 
her; she is fully developed in size; the bones of the face 
are arrested in their development; the jaws and dental arch 
are normal. 

Arrest of development of the tissues of the body can 
take place at any period as a result of the constitutional 
diseases, up to the time when the person gets his full 
growth. Arrest of development of the jaws, however, the 
result of constitutional diseases, to produce dental deform- 
ities, must occur prior to the sixth year. This, however, 
does not include excessive development of the jaw-bones 
proper. It is in the cases like those just mentioned where 
arrest of development is apparently not inherited in the 
parent, but is the result of a constitutional disease which 
afterward becomes a fixed type and is handed down from gen- 
eration to generation. In this way, I believe, we are render- 
ing permanent a deformity of the osseous system which was 
originally an acquired one. 



CHAPTER Will. 

NEUROSES OF DEVELOPMENT OF THE BONES 01 
THE HEAD AND l-.\< I 

Neuroses of development of the bones of the head have 
been rail} considered in the chapter on crime. 

To the great anatomist, Camper, belongs the credit of 
studying the human face from a scientific standpoint This 
great anatomist gave his Dame to the famous facial angle 
which, even up to the present day, serves as a standard by 
which to judge the rank of the human face in comparison 
with the lower tonus of animals. In one of his work- be 
gives, "physical observation on the difference of the feature 
of the face considered in profile, as the heads of apes, orang- 
outangs, of negroes and other peoples, tracing up to the 
antique heads.' ' "You will be astonished," he says, "to find 
among my first plates two beads of apes, then one of a n< _ 
and then one of a camel." Since Camper's time scientists, 
alienists and neurologists have been able, by close study and 
observation of certain peculiar form- and shapes of the face. 
to group typical deformities with certain forms of degener- 
acy. Thus, as early as i s ^'. Groham, who had given much 
attention to facial expression and cranial characteristics, 
anticipated the conclusion of modern criminal anthropolgists. 
II.' wrote: " I have often hem impressed in criminals, and 
especially in those of defective development, by the prominent 
oars, the shape of the cranium, the projecting cheek-bones, 
the larger lower jaw, the deeply placed eyes, the shifty, ani- 
mal-like gaze." Charles Kingsley made the remark many 
years ago: " I have generally seen, with strong animal pas- 
sion, a tendency to high cheek- bones, and who also possess 
dark complexion. These generally are confined to women."' 
Mosso found prominent zygoma? or cheek-bones in thirty per 
cent of sexual offenders against twenty-two per cent normal 
persons. Lombroso says horn criminals have projecting 
ears, thick hair, thin beard, pi _■ frontal eminen 



232 ETIOLOGY OF OSSEOl 8 DEFORMITIES OF 

enormous jaws, a square and projecting chin, large cheek- 
bones and frequent gesticulation. It is, in short, a type 
resembling the Mongolian or sometimes the Negroid. Like 
Lombroso's Negroid or Mongolian types, among criminals, 
so Langdon Down has found the same among idiots, with the 
exception of protruding chin; Langdon Down has in almost 
every case found retreating chins. Tarnowsky, in her work, 
says: "The anomalies of the face are frequently shown in 
asymmetry, prognathism and evident disproportion of vari- 
ous parts of the face. There is a profound excavation at the 
root of the nose." 




Fig. 54. 

While I agree with these authors that prominent cheek- 
bones and protruding and receding chins are apparent 
among the degenerate classes, yet my own experience 
teaches me that other conditions exist which these authors 
have overlooked, which, however, have a great bearing upon 
the degenerate classes. As in the classification of the 
deformities of the jaws and teeth, I have not been able to find 
any two just alike; but it will not do to say that certain forms 
denote idiocy, others criminality, still others prostitution and 
epilepsy. We shall not only find these abnormalities among 
all of the degenerate classes, but among our professions, busi- 
ness men, in school-rooms and even our homes. (Most of the 
cases here enumerated are my private patients, and while I 
am not at liberty to describe each case as I would like, yet 



I III III \l». I \< I . IAW.S \M» I I I I I 






enough can be Baid of each case i<> lt i n » • a clear description. 
It was wnli considerable difficult} I obtained theii consent t«- 
allow me their pictures for this work. In each case the con 
sent was* onlj obtained bj a promise that names should not 
be mentioned and that the object was purely for iciei 

Pirst, what causes the Beeming protrusion of the zyg ••• or 

cheek * »* »ii«*— . and the lower jawl Let us examine the fa( 
tiic following persons, and we Bhall Dot onlj find protrusion, 
luii also arrest of development of these bones. Again, a 
prominence of one side a 1 1 < t an arrest of theother. 



{^ql 


y +w 


mm. 



Pig. 56. 

The following deformities of the face arc due to arrest of 
development These cases arc classified according to their 
deformity, making it easy for the reader to understand them. 

In the following case I could not obtain the consent of the 
patient to use her picture, but the one here Bhown is taken 
from Tarnowsky, and is a correct outline of the face of my 
patient, from whom I obtained the following history: 

Case I, Fig. 54. I- a school-teacher, thirty-two years of 
aire, of a very nervous temperament, bright and well edu- 
cated. Father and mother living; father a periodical drunk- 



234 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



ard; grandmother died of consumption. One of her cousins 
committed suicide, and another became insane. A sister of 
cousin hanged herself. Grandmother, on mother's side, 
became insane, and a grand-aunt committed suicide. She 
was born in the East, but came west on account of a ten- 
dency to consumption. The forehead is very prominent, 
with a marked depression at the bridge of the nose. The 
nose is undeveloped, and has the appearance of falling into 
the face. Hypertrophy of the mucous membrane and bones 
of the nose require her to breathe through the mouth. The 




Fig. 56. 

chest is undeveloped, and she is quite round-shouldered. The 
jaws and chin are fairly well -developed. The alveolar pro- 
cess, although small for the body, has normal dental arches. 
Width outside first permanent molar, 2; outside second 
bicuspid, 1.90; width of vault, 1.60; height of vault .62. 
Third molar not present, and teeth small, hence the reason 
for no deformity. 

Case II, Fig. 55. — Is that of a young man eighteen years 
of age. His mother died of epilepsy when he was two years 
old. Father died of locomotor ataxia about six years ago. 



i ill 111 m«. I \< i . FAW8 vm» I i i I H 

11,. therefore, baa inherited h marked neurotic tendei 
The lower i : i \ s seems to be quite prognathous, irhile the I 
from the upper border of the lower teeth to the superciliary 
ridge, is markedly concave. The Buperior maxillary b< i 
as well as the Eygoma*, are arrested in their development 
The eyes have a sleepy look and are quite deeply set in the 
head; forehead narrow and quite prominent. This seems to 
be a case of atavism. There is a total collapse of the walls 
ofthe nose, difficulty inbreathing, hypertrophy of the tur 




Pig. ."), . 

binated bones and mucous membrane, adenoid growth, and 
mouth-breathing. En this case, we cannot say that the lower 
jaw is excessively developed, because the teeth, which arc 
not large, just till the -pace, while the incisors do not pro- 
trude, and the third molars are in place. The upper jaw, 
however, is greatly arrested in it- development. The third 
molar- are not present. They could not erupt if they were 
there tor want of -pace. (My experience ha- been that the 
third molar is nearly always missing in neurotic- and degen- 
erates. The left first bicuspid ha- been extracted, thus 
allowing spaces t<» occur between tin* incisors. In order that 



236 



ETIOLOGY OF OSSEOUS DEFORMITIE- OF 



the teeth may all come into position, the anterior alveolar 
process has been pushed forward .60 of an inch. If the 
bones of the face had developed, the lower jaw would have 
appeared to a better advantage. This case shows an arrest 
of development of the superior maxilla?, zygoma? and nasal 
bones, with a normal lower jaw. A marked ridge extends 
the entire length of the vault at the suture. The distance 
outside of first molar is 2; outside second bicuspid, 1.75; width 
of vault between second bicuspid. 1; height of vault. .62. 




i^ 



Fig. 58. 

The chest walls are very contracted, the shoulders consid- 
erably stooped, and chest expansion very slight. Owing 
to the death of his parents it is impossible to state whether 
this is a direct inheritance or an arrest of development in the 
individual. 

Case III, Fig 56. — A young man, twenty years of age. a 
marked neurotic; bookkeeper; is above the average in intel- 
lect; has a bright, piercing eye. The appearance of the face 
and jaws are about the same as Fig. 55, with this exception, 
that the zygoma? are a little more developed. Width out- 
side first permanent molars. 2; outside second bicuspid, 1.72; 



tin HEAD, i \« I . i \\\ ft AND TEETH 

between second bicuspid, L. 02; height of vault, 59 There 
ie a total collapse of the nasal openings, causing him to breathe 
through the month Bince he was four years ; the two 

t$ides of the left nostril approximate, while tin- turbinated 
bones upon the right side, owing t.» hypertrophy, till the 
Bpace. A. thickening of the mucous membrane throughout 
the anterior and posterior bares is also observed. This picture 
was taken two years after the contour of the teeth had been 
restored; therefore, the upper lip is more pronounced than in 




Fig. 

Fig. 55. There is, however, a marked concavity of the face 
between the zygomse and the upper jaw ; the upper Lip was 
depressed, as in Fig. 55, before the operation. The chest is 
very contracted, with very little or no expansion on inhala- 
tion. He has an anaemic look, due to'close confinement. The 
father has well-formed jaws, while his mother possi sfi 
marked arresl of development of the upper jaw, showing that 
he has inherited this condition from the mother. His father 
is an honored business man. 

Case IV, Fig. 57. — Stenographer; married; of excellent 
habits and good principles; steady and a hard worker. When 



238 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

a small child his relatives claim that he was a chubby, fat 
boy. His father and uncle possess this arrest of develop- 
ment. This gentleman has two sisters and a brother; one of 
the sisters has the deformity, and a brother slightly. Upon 
examination I find cheek-bones prominent, arrest of develop- 
ment of the superior maxillary bones, a well-formed and 
regular alveolar process and dental arch, fine teeth, and full 
normal lower jaw. Width outside first permanent molar. 
'2. i_V>; outside second bicuspid, 1.90; width of vault, 1.26; height 
of vault, .52. With such a history no one could dispute that 
this deformity was a clear case of direct heredity. The client 




Fig. 60. 

is a little broader than the other two, but there is the same 
weakness of voice that is observed in the other two. 

Case V, Fig. 58. — This man is a graduate of medicine and 
dentistry; above the average in intellect. Father, mother, 
brother and sisters all living: no family history. He was 
born a marked neurotic; a fair dentist, but liked medicine 
better, and would have made a good practitioner; was a good 
musician; could play several instruments, but preferred the 
cornet. Arrest of development of the upper jaw occurred at 
or about the sixth year. As the teeth were crowded, with con- 
siderable protrusion of the anterior teeth and alveolar process, 
there was a pronounced semi-saddle-shaped jaw. Was strictly 
temperate. Died at the age of twenty-six years of general 



Ill I III \l>. I \< I , I \\\ - \\ I) II I I II 






paralysis Width outside first molar, 2.03; outside second 
jpid, 1.90; inside, 1.60; height <>t" vault, .7.*.. 
Casi VI, Fig. ' Vged thirty bii years; married. Born 
in England of English parents. Father sailor. Father died of 
inflammation of bowels; mother, rheumatism of tin- heart. 
\o history; name to America fifteen yean ago. I- in the 
harness business; a man of excellent habits. II< is a 
neurotic The bones of the face are arrested in their develop 
ment The line drawn from the bridge of the nose to a point 




Pig. 61. 



opposite second molar produces a marked depression. There 
i- a marked arrest of the lower jaw. The anterior surface of 
the lower centrals occlude at the tir>t bicuspid; this gives 
the appearance of no chin. All the teeth are present in the 
upper jaw, the width of which i< L.75 outside first permanent 
molar; it i- also a saddle-shaped arch. In order that the 
jaw- may accommodate all the teeth, they have pushed the 
alveolar process and jaw-bones forward. This man has been 
a mouth-breather all his life; the mouth, therefore, has 
always been open; the result is that the teeth and alveolar 
process have grown downward. Although the' lip- are long 



240 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



enough, he cannot close them, owing to the excessive develop- 
ment of the teeth and alveolar process. The alveolar process 
and teeth of the lower jaw are normal in development. The 
height of vault is .82 (this is an unusual high vault). The 
alveolar process is large and thin. This nicely illustrates 
how high vaults are produced. The cheek-bones are also 
arrested, but not to the extent of some. The eyes are deeply 
set; the supercilliary ridges very prominent. The nose is very 
long and thin; the sides of the nose approximate, and there 




Fig. 62. 

is a marked thickening of the mucous membrane: nose- 
breathing is impossible; the chest is contracted, and the 
mouth is continually open. The head is microcephalic; the 
forehead low; the posterior part of the head is very prominent; 
ears large. 

Case VII, Fig. 60. — Twenty-four years of age. Her father 
is now suffering from paralysis. No history; a neurotic; very 
line musician and artist; brilliant conversationalist. Jaw- 
bones proper are well developed. The rami are excessively 
developed, but the teeth and alveolar process are undevel- 
oped. There is very little enamel upon the teeth, and what 



I Ml 



Ml \l». I M I . I \W v \\H M I III 



I I 



remains can be scraped ofl like horn. The otowdj of the 
teeth are worn awaj one-half their length. Width of jaw 
outside first molar, 2.25; outsid< I bicuspid, 2; width 

of vault 1.50; height of vault, .50. She Is unable to b 
the teeth together, and therefore cannot masticate her food. 
To compensate for this Bhe doe- her che^i ing with her tongue 
and the roof of her mouth; on account of which her tongue 
has become hypertrophied to Buch an extent that the jaw baa 
been widened bj the lateral pressure upon the teeth. With 
an effort Bhe can bring her jaws together, which makes her 




Fig. 63. 

pout and the chin protrude, making her resemble an old 
woman. In order to meet this deficiency crowns were placed 

upon all her teeth, which has the effect of bringing her jaws 

at rest in the proper position. 

Case VIII. Elg. 61.— This little fellow is eight years of 
age. His father and mother are Scotch and are cousins. He 
has, what is generally understood to be, an arrested hydroceph- 
alic head; it is. however, a macrocephalic head. He is about 

the average in regard to intellect. The first permanent 
molars have erupted, and the central incisors are just coming 



242 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



through. It is early yet to decide just what deformity will 
be produced, because the permanent teeth are not far enough 
advanced. A saddle or V-shaped arch is sure to follow, 
because there is not room for the cuspids and bicuspids to 
erupt. Arrest of development of the lower jaw is quite 
noticeable at this early age. There is considerable hyper- 
trophy of the superior alveolar process now. Width outside 
first molar, 2; height of vault. .50. This boy will either 
become a genius or a degenerate. It is my experience where 




Fig. 64. 

he anterior lobes of the brain are so prominent and over- 
' developed, that arrest of the upper jaw results. 

Case IX, Fig. 62. — This girl is fourteen years of age. 
Father and mother living. She is a marked neurotic. The 
upper jaw and face were very much undeveloped. The dental 
arch was V-shaped, and the teeth very irregular. This pict- 
ure was taken after the teeth were regulated. The upper 
dental arch was spread .62. The face, therefore, is fuller in 
every direction, and appears at a better advantage than it 
would otherwise. There is excessive development of the 
anterior lobes of the brain, with corresponding fullness of the 



I III ill \l-. KACK, JAWS \M> I I I I II 






anterior par( of the head; -he ia \ « i \ hri^hi and :i tin«* reader 
The i:iw became arrested ;it the sixth year. Width out 
first permanent molar, 1.75; outside second bicuspid, 
width of \:nili. . v i; height of vault, 50. Before treatment 
the face waa verj thin and contracted :ii the alae of the i 
not unlike Figs . .''7. I- n mouth breather; marked 

thickening of tin 4 mucous membrane, and hypertrophy of the 
turbinated bones. While the chest ia very much contracted, 
it is now filling out; Bhe has a busk} voice and :i ven "Id 




Pig. 66. 

face. This case shows how much a face can he improved by 
treatment. 

Case X. Fig. 63. — Seven years of age. Father and 
mother living. No history; both have well-developed jaws. 
The anterior Lobes of the brain are excessively developed, and 
the anterior part of the head is quite high and prominent. 
This boy has always been ;i mouth-breather, and ha- been 
sick most of his life; he had so little vitality that it was with 
difficulty that he has been raised to this period i)\' life; he i> 
now very delicate. Deflection of the septum, hypertrophy 
of the mucous membrane, and turbinated hone-. The mouth 



244 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



has been kept open to such an extent that occlusion has not 
taken place. The rami are short; the result of this is, 
nature has caused an excessive development of the anterior 
alveolar process. Width outside first molar, 2; outside 
second temporary molar, 1.75; width of vault, 1; height of 
vault, .36. I expect that the face will remain undeveloped 
from this period. 

Case XI, Figs. 64 and 65. — Aged thirteen years. Father 
and mother living; father a paranoiac; has an excessively 
developed forehead and well-developed jaw. The boy is a 




Fig. m. 



marked degenerate, almost bordering on imbecility. The 
anterior cerebral lobes are well developed, and the forehead, 
like the father's, is also well developed. The face looks like 
that of a man thirty-five or forty years of age. The whole 
body is arrested in its development. His legs are short and 
he walks like a man of seventy. The joints are large, while 
the bones are very small, showing impoverished blood. 
There is a marked arrest of development between the super- 
cilliary ridges and the zygoma?, and also the lower jaw; 
this gives an apparent protrusion to the nose and upper jaw. 



I II I III \l >. KA< 



.1AW.S V.N I) I I I I II 






The eyes and their sockets are also arrested, and be is obliged 
to wrear glasses on account of astigmatism. The bones of the 
oose are well developed and there is plenty of breathing 
space. H< baa a growth of fine, white hair all over bis I 
The ears are undeveloped, consequently the bearing 
affected. Width outside first permanent molar, L.84; out 
side second bicuspid, L.75; width of vault between second 
bicuspids, .84; height of vault, .."' ,| . While the boy was 
under treatment, I prescribed beef, wine and iron, which be 
Deeded, owing to th>' Impoverished condition of the blood. 




Fig. 67. 

Hi- father would not let him take it because it contained wine. 
I then put bim on gentian. When the treatment was about 
half finished, I Bent in a Mli. The father wrote in reply thai 

he was out of money, and that I mu-t trust in the Lord. I 

have been doing bo for the past three years. 

Case XII, Fig. 66. — This young lady, sixteen years of 
age, came to me to have a deformity of the mouth corrected, 
four year- ago. Her mother is a neurotic: her father. 
although a large, fleshy man. has small jaws. Marked arrest 
of development of the bones of the face ha- taken place. 
She possesses a very thin nose, deflection to the left of the 



246 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



septum; enlarged right inferior turbinated bones, andhypertro- 
phied mucous membrane. She is a mouth-breather like Fig. 
63 — the mouth being kept open. The anterior alveolar pro- 
cess has developed downward, causing the teeth to protrude. 
Width outside of first molar, 1.95; outside second bicuspid, 
1.65; width of vault, 1; height of vault. 47. 

Case XIII, Fig. 67. — Excessive development of the bones 
of the face. This lady, thirty-two years of age, married, has 
one child. Father and mother living and in perfect health. 




Fig. 68. 



She is healthy in every respect and above the average in 
intellect. Bones of the face normal, except zygomse, which 
are excessively developed. 

Case XIV, Fig. 6$. — This young man was born and raised 
in Boston. He possesses a weak physical make-up; has 
very contracted chest and stoops. Marked arrest of bones of 
the face. Long, slender nose, the outer Avails coming in 
contact with the inner, and is therefore a mouth-breather. 
There is a slightly excessive development of the lower jaw. 
He was supposed to be in consumption, and was ordered 



Mir ii i \i '. i \< i . i \\\ - \\ i > i i » i ii 



'I 



west. The change of climate and out door e> • ive com* 

pletelj restored him t<> health. 

Ca81 XV, I This gentleman, a medical student, 

possesses about the same histor) ( \l\ He, however, 

has a more marked deformity. There is a great arrest of 
development of the bones of the face, and a more marked 
protrusion of the ohin; this, however, does not show, owing 
to the beard. 

In comparison of these cases there Is very little difference 




Fig. 69. 

in width of the upper jaw in the first five cases. Three are 
2. one 2.03 and one 2.25. Fig. 54 shows arrest of develop- 
ment at the bridge of the nose. Fig. 55 shows arrest of 
development of the bones of the face extending from the 
Bupra-orbital ridge, including the eyes, zygoma? and superior 
maxilla', presenting a concavity of tin- face as far down as 
the superior border of the inferior teeth. Fig. 56 is precisely 
Like Fig. 55, with the exception that the zygoma? are -till more 
developed. Fig. 57 is exactly like the last two. with the 
exception that the zygomee are -till further developed. In 
Fig. 58 the feature- are -till more normal, but arrest of 
development is noticed at the alee of the nose. Fig. 59 not only 



248 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

shows arrest of development of the bones of the face, but also 
marked arrest of the inferior maxilla. The apparent prog- 
nathism is the same in all except Fig. 59. This is not exces- 
sive development of the lower jaw, but a normal develop- 
ment. The lower jaw develops independently of the bones of 
the head, and, owing to its mobility, usually develops nor- 
mally. The apparent prognathism is due to arrest of the 
upper jaw. 

In a large proportion of cases, however, the face is nor- 
mal, and the undeveloped lower jaw is present. Again, the 
bones of the face are normally developed upon one side and 
arrested upon the other. In these cases all the conditions 
presented in the chapter on the development of the bones of 
the face are readily seen. They indicate the period at which 
the part of the brain which presides over the function of 
development of the osseous system ceases to operate, leaving 
the bones in an undeveloped state. 

Comparing these faces, and their deformities, with those 
of the degenerate classes the deformities of one do not differ 
from the other. The make-up of the contour of the head, 
face, jaws and ears of Prendergast, and other degenerates, 
differ from others only under dental observation. The ques- 
tion naturally arises, at this point, as to how frequently 
stigmata occur with people in the common walks of life. 
Repeated examinations in street and steam cars, medical and 
dental colleges, halls and practice in and about Chicago have 
given the following results In practice 6S per cent, in halls, 
cars, etc., from 45 to tio per cent; in a billiard hall, out of 128 
persons either playing or looking on, 72 or 87 per cent of 
deformities of the face and jaw^s. In medical and dental col- 
leges, where students come from the country and different 
parts of the United States, the percentage will fall as low as 
45 per cent, while in the congregation of city people the per 
cent of deformities will range from 55 to 65. It would not 
be fair to take the percentage of my patients into considera- 
tion, because my practice is made up largely of the treatment 
of irregularities of the teeth. In analyzing the large percent- 
age, found in dental examinations, the fact should be remem- 



I in HEAD, l \< l . JAWH \M» I l I I II 






I that irregularities of the jaws aod teeth oome under 
obsen ation in large numbers for special treatment. It would, 

\ er, be Bafe to >a\ that from 56 to 60 per oent p 
these deformities. Taking the defective classes as a whole, 
as found in our asylums, the percentage of deformities 

reen them and Bocietj at large is not striking. If, how 

. congenital cases, habitual criminals, drunkards, prosti 
tutes, paupers, etc., be considered, the percentage is from 85 

5 percent. Stigmata, as has been shown in the chapter 
on development of the face and jaws, appear before or at the 
sixth year. This illustrates conclusively that the brain cen 
ters which preside over the osseous development arc affected 
at or Boon after birth. 

In the present state of our knowledgeof brain development, 
the question arises, why la it that two persons possessing the 
same deformities of the head, face, jaws and teeth, one is a 
criminal, idiot. Inebriate, pauper, the other a business man 
orgeniusi The answer naturally suggests itself, that while 
the nei \ e centers of the brain which preside over the develop- 
ment of the osseous Bystem are the same in both cases, pro- 
ducing the -nine results, other nerve centers of the brain 
which preside over the intellect continue to develop in the 

ud period of brain growth, between the sixth year and 
puberty. Character matures parijpaMu with other develop- 
ment; the whole period of youth is a formative one, and it 
cannot or ought not be unduly handicapped by an osseous 
system practically fixed in the first decade of existence. 
These cells may develop in one Line producing genius, or they 
may develop uniformly, producinga well-balanced brain. In 
the other case, the nerve centers in the second period remain 
undeveloped, and the idiot, criminal, inebriate, pauper and 
prostitute results. Thus we find stigmata in persons poss as 
ing a normal brain, and it is possible to find neurotics and 
degenerates with a normal osseous development. 

It will now be -ecu why modern medical jurisprudence, in 
passing an opinion on a case of alleged idiocy, insanity, 
inebriety, prostitution, pauperism, criminality, etc., should 
take particular care to examine the face and jaw external and 



*25<l ETIOLOGY OF OSSEOUS DEFORMITIES 

internal, thereby fixing the date of abnormal development 
due to inherited or congenital defect. 

Regarding the comparative degeneracy of foreigners and 
Americans, it seems probable that stigmata are not as marked 
in American-born criminals as in foreign. This seems due to 
the fact that in the old world, consanguinity, long lines of 
drunkards and prostitution, and marriage of criminals, have 
had great influence upon these aberrations. Scientists and 
specialists in this country are of the opinion that the more 
marked degenerate types are imported individuals. As this 
country develops in age with the large immigration of foreign- 
ers, together with our own criminals, paupers, etc., these 
excessively marked degenerates, as illustrated by Lombroso, 
Ferri, Manouvrier and others, will become more numerous. 
In an examination, by the aid of a magnifying glass, of the 
photographs of epileptics and insane criminals in Lombroso' s 
atlas — L'Homme Criminel — although these are very small 
and indistinct, the following deformities of the face and 
iaws are found: 

Arrest of the bones of the face and superior 

maxillse, - - - 98 

Arrest of the lower jaw, - - - 32 

Excessive development of the upper jaw, - 11 

In an examination of photos of criminals in the Bertillon 
collection, in the French Building at the World's Fair, the 
following results were obtained of 115 examined : 

Arrest of bones of the face, - -54 

Arrest from orbit to lower jaw, - - 24 

Arrest from zygomse to lower jaw, - 30 

Arrest of lower jaw, 65 

All have large, prominent noses; many sunken eyes, and 
not a few are cross-eyed. This attempt to classify these 
deformities (not for the purpose of obtaining percentages, 
which is out of the question with pictures) is. simply intended 
to show that they exist among degenerates in other countries. 



CHAPTER XXIV. 

NEUROSES Wl» I OMPENS \ COR* 1>K\ ED >l'ML\ I 
OF THE BONES OF THE NOSE 

It would be difficult to understand whj the bones and Boft 
tissues of the nose are nol just as liable to ahow stigmata of 
degeneracy as the facial and maxillary bones. Indeed, such 
ie the case. Deformities of the nasal septum, deflection, 
hypertrophy and atrophy oi the turbinated bones, and defor- 
mities of the maxillary sinuses, are almost always associated 
with arrest and excessive development of the facial and max- 
illary hone-. This is naturally to be expected; and. in the 
history of cases already, mentioned, and hundreds of cases 
examined by me in the past few years, there is hardly 
a single instance in whirl) some deformity of the nose is not 
noticed. They are naturally associated together. While it 
is possible to occasionally find deformities of the maxillary 
bones without deformities of the nose, so it is possible to find 
deformities of the nose without maxillary deformities. My 
experience has been that there are very few normal septa. 

Theile examined 117 Bkulls and found the septum nor- 
mally placed in 29. Semeleder examined t9andfound the 
deflection to the left in 20, to the right in L5, and a Bigmoid 
deformity in \. Harrison Allen, in 58 Bkulls, found narrow- 
ing to the left Bide in 19, to the right in 21; in >ix of the 
latter the septum and superior and middle turbinated 

bones met. 

Zuckerkandl believed that the dry Bkulls did not give an 
accurate illustration of the true condition, and then made his 

arches upon the cadaver. Out of 370 cases he found 123 
symmetrical, and 11" asymmetrical; in the deformed speci- 
mens, the septum was inclined to the right in 57 cases, to the 
left in 51, and was sigmoid in 32. Mackenzie examined 
2,152 Bkulls in the Museum of the Royal College of Surgeons 
and found 1,657 cases where the septum was more or less 
deformed. In 834 the deviation was to the left, and in 



851 



252 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

to t lie right. In 205 the deflection was sigmoid, while in 5 
the irregularity was zigzag, showing 70 per cent of deformi- 
ties in the dry skulls, and only 40 in the cadaver. Heyman's 
examination showed 99 per cent of deformities in living sub- 
jects. With the status already shown, there seems to be 
quite a difference in the percentage of deformity as regards 
races. Thus Zuckerkandl found in 103 cases of barbarous 
and semi-barbarous people 24 were asymmetrical. Mackenzie 
found in 430 skulls of superior races 22.6 per cent of defor- 
mities, and also confirms the observation of Zuckerkandl. 

Harrison Allen found, in 93 skulls of negroes, deformity 
of the septum in 21.5 per cent. The author has examined 
over 11,000 skulls in this country and Europe, including the 
large collection in the Museum of the Royal College of Sur- 
geons, and 347 living individuals, with the following results: 
Owing to the fragility of the septum the whole or anterior part 
was lost in many of the skulls, the result of which only 7,600 
had sufficient bone remaining to give any idea of its shape. 
My examination of skulls in the Royal College of Surgeons, 
London, practically tallies with Mackenzie. In the 7,600 
skulls, 5,762 showed marked deformities. Out of 687 ancient 
Peruvian skulls, 147 possessed deflection of the septum. In 
69 stone-grave Indians, 35 were normal and 34 deformed. In 
18 mound-builders, 8 were normal, 10 deformed; 6 California 
Indians, 4 were normal. 

Dr. J. M. Whitney, of Honolulu, brought 28 skulls of 
ancient Hawaiians to the Columbian Dental Congress which 
met in Chicago, August 14th, 1893. These were taken from 
lava caves. There is no question of their antiquity, many of 
them possessing the appearance of the Neanderthal skull. 
The jaws were unusually well developed, as well as the bones 
of the face. The external bones of the nose were also well 
formed. While there was a lack of that marked asymmetry 
due to excessive arrest of development of the turbinated 
bones, as noticed in the Peruvian skulls, yet the bones were 
far from being uniformly located in the cavities of the nose. 
There were, however, two in which the inferior turbinated 
bones were undeveloped, only rudimentary ridges being pres- 



I II I II I \l>. I \< I . I \\\ H \\|, I I i i || 

ent. Deflection ol the septum was noticed ii some 

in the anterior pari of the bone, others In the middle, and still 
others in tin posterior part. In the two rhere the 

interior turbunated bone was undeveloped the septum deflected 
to that side. Nature not seeming to be satisfied with the 
amount of material at hand built out projections a hich seemed 
to take the place of the missing turbinated bones. One very 
singular case was observed when' the deflection commenced 
midway, from before backwards, the greatest deformity being 
three-fourths its distance into the left cavity, midway betw< en 
the turbinated bones. Upon that Bide of the vomer there was 
a large ridge, its greatest projection being about .25 of an inch 
in length. Upon the opposite Bide there was another smaller 
ridge, evidently for i he purpose of supporting the deflected 
point, and also for the purpose of affording greater surface 
for mucous membrane and blood-supply. Of the 347 living 
persons. L07 showed deflection of the septum. 

1 have shown, like deformities of the other bones of the 
cranium, face and jaw, that it makes no difference whether 
the individual was of the ancient or modern, barbarian or 
civilized, all possess these deformities of the septum. No 
two are alike, nor can we find any one growth resembling 
another in number. Loewenberg, Mackenzie and [ngalls 
have classified these deformities, but the author will not 

attempt to do so for two reasons; Urst, he did not study the 

deformities with that object in view; and, second, from years 
of observation he is of the opinion that each case is a peculi- 
arity in itself. 

I have given these figures in detail because it will be seen 
that in the original examination of the skulls of the cadaver 
and living individuals, there is no uniformity in the figures. 
The author does not believe that it make- any difference in 
the deformity of the septum whether the subject i s alive, on 
the dissecting table, or the skull has been grinning from the 
Bhelf of a museum for twenty years. The two point- of 
attachment are fixed (if the patient has reached puberty), and 
the septum, green or dry, cannot very well change it- | 



254 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

tion, except that there may not be quite so marked a deflection 
in the dry subject. 

If the deformity were of a sigmoid nature upon one side, 
or the shape of the letter S, the part of the bone or cartilage 
being dry would prevent its changing to the opposite side in 
the one case, or a reversal of the S-shape in the other. It is 
easy to see why it is more difficult to diagnose deflection of 
the septum in the living subject or cadaver than in the dry 
skull, on account of the soft tissues located in the anterior 
part of the nose. This, no doubt, will account for the small 
percentage of deformities reported by Zuckerkandl and the 
author. I found great difficulty in making my examinations 
upon living individuals; indeed, I am well aware of the fact 
that it is almost impossible to discover the contour of the 
vomer in its middle and posterior parts, where the}' are as fre- 
quently observed as in the anterior part. This deformity was 
of all manner of shapes, sometimes like the letter S, again 
the letter C, and often like the small italic letter f. Some- 
times it would be carried over so far as to approximate the 
right or left outer wall of the nose. From the fact that it is 
attached throughout at its upper and lower border to a solid, 
bony frame- work, its middle portion is liable to bend in any 
direction like a loose sail in the wind. Deflection of the 
vomer, due to fracture of the cartilage, or the deflection of 
anterior part of the nose, is easily differentiated from a fract- 
ured vomer. 

Several theories have been advanced as to the cause of 
these deformities. Quelmalz and Schultz believe that they 
are due to the action of astringents drying up the membrane, 
causing it to contract, thus drawing the bone and cartilage 
down upon itself. Morgagni believed that it was due to 
excessive development of the vomer. The view held by many 
is that advanced by Trendelenburg, that it is due to a crowd- 
ing up of a high-arched palate, as he had observed the two 
conditions so frequently connected. Jarvis has reported four 
cases, all in the same family, which would suggest that it is 
due to an hereditary taint. It would be very difficult to 
establish this theory because of its frequency. If the doctor 



I III HIM'. 1 \« I . .1 \u - \\|. 1 I I I II 

bad Mid that the neurotic or degenerate conditions which 
underlie tl>«' building up ol the system were inherited, it 
would Beam to me to be more plausible. Schaus' and 
Welcker' s investigations tend tosho^ thai there is a faulty 
development of the facial skeleton, but in just what manner 
it i- impossible t<> Bay. Tin' author agrees with this theory. 
Boswortb ami oilier- believe thai septal deformities are due 
to traumatism. Boawortfa Bays, page 288: "The clinical his- 
tory of many of these cases affords direct evidence of tin-, 
and even in th08e cases in which the direct injury ;- not tea 
titled to. 1 think it sate to say that an injiin ha- occurred, 
which may have been of M > Blight a character ;is Dot to have 

ex< ited especial attention at the time of the occurrence. An 
injury to the nose need not necessarily give rise to the 
immediate development of a notable deformity, as in 

fracture, but it may set up a low grade of morbid 
action, which, going on through a number of years, will 
finally develop a condition by which the normal function 
of the nose is Beriously hampered." He also Bays, on \ 
291: "The point on which I would lay special emphasis is 
that the deformity is primarily the result of traumatism, and 
secondarily of a slow inflammatory process which results 
therefrom." That a very few cases of deformity and fracture 
of the septum are due to traumatism. I believe to be true. 
The author i- well aware of the fact in one casein particular, 
when a boy of Bixteen, he asserted his rights, when lie 
received a blow upon the nose from his opponent which fract- 
ured the cartilage and made a tasting impression upon him. 
That from 50 to 80 per cent, or even 5 percent of deformi- 
of the septum, are due to such injuries, I believe to be 
out of the question. In the large number examined by the 
author. 2,684 possessed what appeared to be fracture. The 
vomer in many of these Bpecimens commenced to deflect at 
it- outer surface and gradually deepened until, at about its 
middle or posterior two-third-, it reached its deepest part and 
then gradually decreased in depth until the posterior attach- 
ment was reached. It- appearance was not unlike the sail of 

* "Diseases of the Noee and Throat." 



250 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

a ship. On the convex surface, in many cases, nature had 
thrown out provisional bone to support this curvature, which 
might be considered a break, but in most cases simply a 
bend. That a blow, whether slight or as powerful as could 
be given by a Corbett, could produce a fracture of the vomer, 
the greatest deformity of which is located from . 75 to two 
inches inside the nose from the point of the nasal spine, would 
hardly look reasonable. Anterior and posterior to this deflec- 
tion, the vomer appeared in most cases to be nearly or quite 
normal. In nearly every case the fracture would involve 
only one-half of the vomer, the other simply bending; so that 
such a condition could be brought about by a blow is absurd. 
It seemed that the point of the greatest deformity was the 
thinnest part of the bone. 

It would appear to be a very easy matter in the skull to 
decide whether a fracture had taken place before or after 
complete ossification by the character of the wound, thus 
approximating the date of the injury. That it was caused by 
a low form of inflammation, set up as a result of a slight 
injury in utero or after birth, does not seem to be a rational 
theory, because the inflammatory condition must necessarily 
extend upon both sides of and through the septum, extending 
its entire length. If due to an inflammatory condition the 
bend or break would be found at any part of the septum, and 
the position and shape would be different in every case. As 
the location upon the septum, from above downward, is 
nearly always the same, and as the shape is always from 
before backward, inflammation could not produce it. In 
order, therefore, to produce a fracture, w r e must first have an 
excess of septum. Therefore, unless the fracture is the result 
of a direct blow, it would require years to produce sufficient 
growth and curvature to produce a condition in which fract- 
ures, or even an abrupt bending, could take place. 

The theory, then, that the deformity is "primarily *' the 
result of traumatism due to injury in utero, or at the time of 
delivery, or even subsequently, except by direct force, and 
secondarily to a slow inflammatory process, to my thinking, 
will not account for these deformities. Indeed, fracture of 



i 111 HEAD, FACE, J A W8 AND TEETH 

soft tissue, Buofa as the vomer before ossification, is qo1 p< 
ble. The theory advanced i>\ Trendelenburg, and supp 
i»\ iii:in\ specialists today, ia bo absurd thai ii would 
almost unnecessary to Baj anything about it at this time, but 
as tlii— theory is still taught in our medical colleges, I deem 
it necessary to call the attention of specialists to some of its 
absurdities. I will Bay, however, at the start, thatwherevei 
we find a high, contracted vault, we also observe a defl< 
septum. Often, however, a deflected septum is found with- 
out a high, contracted vault While the high vault and 
deflected septum go hand in hand, the one does not produce 
the other. It has been shown, in th<' chapter upon the devel- 




Fig. 7". 

opment of the vault, that it is developed downward and not 
up. The development of the suture which unites at the 
median line, is precisely like Laying the keel of a ship, only 
upside down: it is laid first and is the foundation upon which 
the superstructure rests. The narrow, contracted vault i- 
never seen before the sixth year, except in cases of monstros- 
ities. Many septa are deformed before that date. There is 
nothing, then, to cause the upward movement of the vault. 
The ridge is not the result of a pushing down of the suture 
by the vomer. The vomer would have to become taut to 
accomplish this, hut we always find it bent in such cases. 
Again, if the ridge was produced by the action ni the vomer 
it would he nearly or quite uniform in thickness it- entire 
length, hut this i- never the case. If it were possible 



258 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

crowd down the middle and posterior palate, it would be 
impossible to crowd down the anterior part of the palate, which 
is covered by the anterior alveolar process. I have fre- 
quently observed a ridge extending along and including the 
alveolar process as far as the incisor teeth. I have examined 
1,367 skulls containing vaults so depressed, but have never 
been able to find a corresponding depression in the floor of 
the nose. 

Again, it would be as impossible to force down the vault 
at the median line as it would be to force a keystone through 
a brick or stone wall by the weight resting upon it. The 
author, and others, have shown that deformed septa are 




Fig. 71. 

common among early and pure races, who do not possess con- 
tracted arches; so that it will be seen that one is not depend- 
ent upon the other. As regards the length of the septum, I 
agree with Morgagni, that it has developed beyond its normal 
size, and in order that it may accommodate itself to its sur- 
roundings, it must deflect either to the right or left. Sta- 
tistics show, in some cases, that the right side has the prefer- 
ence; others show that the left side is more favored, and 
again, that it is about evenly divided as regards deformities. 
Let us now examine some of these cases and see if we 
can throw any light upon this subject. The first seven cases 
are Peruvian skulls from Harvard college. Figs. 70 to 73, 
inclusive, are well developed, while Figs. 74, 75 and 7<> are 
arrested in their development. These photos, were taken by 



I III III \l>. I M I . I WV - \ N I • 1 I I 1 II 

a regular photographer, and were arranged bo m to get m 
much light Into the cavities as possible. Some, howevei 
quite unsatisfactory, for, while the} -how th<' septum, the 
turbinated bones and surrounding parts are not well illua- 
trated. Fig. 70 shows the septum deflected to the left pest 
ing upon the inferior turbinated bone <>t' that side. The 
right turbinated bones (which are poorlj shown are ex< 
i\ ely developed, to such an extent that while they do n<>t 
quite touch, they take the contour of the nasal septum. Fig. 71 
-how- a Bimilar condition, while the oasal septum is not 
deflected quite as far. The right superior turbinated bone is 
excessively developed, hut nut to the extent of the inferior 




Pig. 7i'. 

one. Fig. 72 -how- a septum almost straight The left 
inferior turbinated hone is nicely shown. The other turbi- 
nated hone- are also excessively developed, but do not extend 

so far forward. Also notice that the septum is divided into 
two part-. It will be observed that in the other two, unlike 
this one. the turbinated bones arc arrested in their develop- 
ment upon one side, and excessively developed upon the 
other. Both cavities are entirely, but uniformly, filled with 
complete masses of soft, spongy portions of the turbinated 
bones. Stigmata of degeneracy are marked all over the 
Bkulls, while the cavities of the nose are -mailer, or am 
in their development The two sides of the face are quite 
unlike, and the orbits are very much undeveloped. There is 
a marked arrest of development of the left maxillary bone. 



260 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

which contains an antrum only about one-half the size of the 
right side. The arrest of development has caused the teeth 
to be forced out on a large circle, in order that they may 
come in contact with the lower teeth. This action has caused 
the roots of the teeth, in many cases, to protrude through the 
outer plate of alveolar process. The mastoid processes are 
also excessively developed. A profile view was taken of 
this skull (Fig. 73) in order to obtain as good a view as pos- 
sible of the large right inferior turbinated bone. This bone 
is so large that it extends nearly to the floor of the cavity. 
The most remarkable point in regard to this deformity, out- 
side of the excessively developed turbinated bones, is, that 




Fig. 73. 

not only is the septum deflected to the left until it rests upon 
the wall of the cavity, but that the nasal spine is also deflected. 
Fig. Ti shows nasal cavities arrested in their development. 
The septum is but slightly curved to the left. The nasal cav- 
ities are filled with excessively developed turbinated bones, 
and the spaces between the turbinated bones and the vomer 
are about evenly divided. Fig. 75 shows a very small nose, 
the vomer is deflected to the left below, and at about one- 
third of the way up it takes a decided turn to the right. In 
the examination of the turbinated bones the right inferior 
bone is very large, the left very small, while the reverse is 
the case in the two upper bones. Fig. 76 also shows stig- 
mata of degeneracy in the nasal cavities. Here the vomer is 
about straight, while the turbinated bones upon both sides 



I III II I \l '. I \< I . I \\\ - \\ I » MINI 

are so large that they fill the cavities; the spaces between, 
however, are uniform upon both sides. We have do* 
that deflection of the septum and excessive development of 
the turbinated bones are associated with large, well-formed 
nasal ^cavities, as well as with small, contracted cavities in 
ancient as well as modern people. The same relation exists 
between the vomer and turbinated bonesin all the skulls as well 
a- in li\ iiii: persons. The extent and location of the deformity 
depends upon the extent of development and location of the 
turbinated bones. They may not necessarily be excessively 
developed or arrested in their development, but if the outer 
walls arc -mall, reducing the Bize of the nasal passages, and 




Fig. 74. 

the turbinated bone unevenly situated <>r nearly filling the 
cavity, the septum will deflect to the right or left and conform 
to their shape, leaving uniform -pace- throughout the entire 

length of the bone. Inhalation and exhalation ran-.- the 
vomer before or during ossification to deflect to the right or 
left, according to the size and location of the turbinated 
bones. The air striking the septum, just as the wind strikes 

the sail of a boat, produces uniform Bpaces between the sep- 
tum and turbinated bone-. The bend or breakage is almost 
invariably at a point of the concavity just midway between 
the two turbinated bones on that side, and at the thinnest 
part of the vomer. When the turbinated bones are unde- 
veloped upon one side and excessively developed upon the 
other, the force of air causes the vomer to bend toward the 



2C)2 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

smaller turbinated bone, thus lengthening it, so that the air 
will enter and leave uniformly upon both sides, as illustrated 
in Figs. 70 and 71. If the turbinated bone is large upon one 
side, the force of air will cause the unossified vomer to 
develop, and if the cavity of the nose is large, the whole vol- 
ume of air will eventually strike the vomer upon one side, 
causing it to bend right or left until the air is uniformly dis- 
tributed or it comes in contact with the turbinated bones upon 
the opposite side. In Figs. 7± and 76, the turbinated bones, 
developing nearly uniformly upon both sides and filling the 
nasal cavity, give no opportunity for the septum to deflect to 
the right or left. The spaces, therefore, are uniform upon 




Fig. 75. 

both sides. It is also safe to say that when these bones are 
covered with mucous membrane that the nose was com- 
pletely filled, and that these persons were mouth-breathers. 
Associated with unstable development of the superior 
maxilla and bones of the nose, we must necessarily have 
unstable development of the mucous membrane, resulting in 
a thickening of the membrane and adenoid growths. These 
conditions are almost always to be found in connection with 
stigmata of degeneracy. We can now see why, in idiocy, 
imbecility, etc., patients possessing (apparently) high vaults, 
are mouth-breathers. There is an arrest of development of 
the bones of the face, jaw and nose. The patient cannot 
breathe through the nose; the mouth being open the teeth 
and alveolar process develop down for want of antagonism; 



I ill ill \i». I \( i . i \w - iND TEETH 

:m-l the contracted vault, which looks high because o! the 
arrest of dei elopment , results. 

h is quite common to 6nd entire arrest of the inferior 
turbinated bones upon one Bide or upon both sid< s. A ir.-iin. 
one or both inferior turbinated bones will be partially devel 
oped. 

The following skulls, in the Armj Medical Museum at 
Washington, possess such deformity 

Alaska Indians — 

Skull No. L,090, case 177; lower right turbinated bone 
undeveloped. 

Skull No. 1,092, lefl inferior turbinated bone unde- 
veloped, vomer gone. 

Skull No. L,094, both inferior turbinated bones unde 
veloped. 

Skull No. 2,431, no inferior turbinated bone. 

Skull No. 2,453, no inferior turbinated bone. 

Skull No. _.7'. <v . no inferior turbinated bom-. 

Skull No. 2,451, no left inferior turbinated bone. 

Skull No. L,216, case 180; both inferior turbinated 
bones undeveloped. 
Many Peruvian skulls show undeveloped inferior turbin- 
ated bone-. Thus: 

Skull No. 630, ease L66; no right inferior. 

Skull No. 631, case I6t5; no right or left inferior. 

Skull No. L15, case I.67; no left inferior turbinated 
bone. Individual over twenty-two year- of age at 
time of death. 

Excessive development of the turbinated bone- i> also 
very common. Thus, No. 2,131, case L75, Vancouver Island 
Indians: The right middle turbinated bone is excessively 
developed, so that it fills the anterior middle ^i the nasal cav- 
ity with a large cavity in the -enter. The left middle and 
right and left inferior bones were well developed, filling both 
nasal cavities. In this case the vomer, which stands uni- 
formly between the turbinated bones take-, the shape of the 
letter S. No. l\ 1 l:i*. Vancouver Island Indians, show- left 



264 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

superior turbinated bones; excessively developed to a level 
with middle turbinated bone. The vomer is deflected to the 
right, then to the left, in order that it may stand in a central 
position. Skull 1,309, case 173, illustrates the theory of the 
author very nicely. The right middle turbinated bone unde- 
veloped, interior right excessively developed; the vomer at 
its middle takes a V-shape, in order that it may stand in the 
middle between the turbinated bones. 

That inhalation and exhalation govern the development 
and shape of the bones of the nose is nicely illustrated in many 
ways. When the nasal cavities are small and the bones 
become enlarged upon one side, the outer wall will become 




Fig. 76. 

concave, encroaching upon the antrum. Again, when the nasal 
cavities are small, the turbinated bones will develop and curl 
upon themselves so that uniform space is obtained for the 
passage of air. In a long, narrow nasal passage the bones 
will develop long and narrow; the superior turbinated bone 
will develop down, sometimes below the lower edge of the 
superior turbinated bone. In other cases the nasal cavities 
will be short and broad. In these cases the bones will 
become large and short. I have seen them develop straight 
out from the outer wall, and then turn upon themselves back 
to the point of origin. Sometimes they are very thin and 
dense, like the vomer. Again, they are thick and cancellated, 
like the spongy alveolar process. Occasionally one nasal 
cavity will be lower than the other. In such cases a corre- 



I III III \l>. I \< I . .1 \W - \\ I • I I I I II 






spending deformity is almost Bure to result io the vault. 
When the nasal cavities arenol uniform in development that 
is, narrower in front than behind the turbinated bones will 
develop posteriorly, and either become undeveloped anteriorly 
or will curve more, bo that air may be evenlj distributed 
throughout the cavity. When the turbinated bone develops 

jer or smaller behind than in front, the bone will bend 
upon itself to conform to this deformity . 

Skull No, 736,0886 L79, hasalsoa very marked deformity 
of the vomer; it is bent in both direction-. The anterior half 
is midway between the turbinated bones, while the posterior 
half is bent to the right, the greatest point being between 




the right upper and lower turbinated bone-. Both concavi- 
ties nave projections — one to the right, the other to the left 

The anterior curvature of the vomer is the largest, and for 
this reason the left turbinated bone is undeveloped. This. 
however, doe- not allow sufficient loom for the air to become 
evenly distributed through the nostril upon one side. The 
most remarkable thing is that to procure room the air had 
forced the vault of the mouth on that Bide downward, making 
a very marked and noticeable deformity. The dental arch i- 
well developed. 

Occasionally the turbinated bone- are BO situated that the 
air will deflect the vomer to one side or the other in such a 
manner that there will be a deformity at right angles, just 
below the inferior turbinated bone. This, however, cannot 



266 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



be located very near its place of attachment, for the reason 
that the vomer commences to enlarge or thickens as it reaches 
the nasal spine, thus preventing the bend. 

The drawings of Zuckerkandl are here given because they 
illustrate the very points which I have made, and because they 
are true to life. 

Fig. 77 shows the bone very unevenly developed. This 
is partly due to an excessively developed antrum upon the 
left side and a correspondingly small one upon the right side. 
It will be noticed that the turbinated bones and vomer are so 
distributed that there is a uniformity of space throughout the 
cavity. The vomer even has deflected to the right in order 




Fig. 78. 



to produce this harmony. It will be observed, however, that 
the bone is not broken, but simply bent, and that this bend is 
about opposite the enlarged left inferior turbinated bone. 
Although the face is very asymmetrical, the bones, which are 
intended for the purpose of warming the air, are nicely 
arranged. The right cavity is considerably lower than the 
left; the inferior turbinated has lengthened to correspond. 
Aspiration has separated the lateral halves of the vomer, and 
the space has filled in with bone. 

Fig. 78 is quite another case. Here we see the facial bone 
uniformly developed; the antra are comparatively uniform; 
the turbinated bones, however, are very unevenly developed. 



I III HIM 



I \< I 



I \\\ 



\M> I I I I II 






The bend and break in the corner are about at b point 
between the two turbinated bones, and exactly opposite the 
. \ i ssiveh developed right inferior turbinated bone. It will 
be observed thai the bend is do greater in the one than in 
Big. 77, and yet in Fig. 7 v thelefl plate is fractured, while the 
right one is slightly bent. This is usuall} the ease. There 
i- not :i complete fracture, but a semi fracture. 

Fig. 79 shows Btill a different condition. The left antrum 
i- Dearly closed; to compensate for this a number of sinuses 
are formed. In order that the air may be warmed uniformly 
the Beptum has developed to the Left The lower pari has 
enlarged, and the middle has deflected to the right thus 




Fig. 79. 

giving a more uniformity of spaces. The right interior tur- 
binated bone has also enlarged for the same purpose. 

Fig. v " i- a splendid illustration of arrest of development 
of the bones ^\ the tare, nose and jaws. The bones are very 
unevenly developed, with excessive development of the left 
superior turbinated bone, which has a cavity in it no doubt 
for the purpose of producing more surface for the blood-sup- 
ply. An individual with such a development must to 
sarily possess a degenerate condition, with weak Lungs, small 
chest, and low vitality. In order that the air may be uni- 
formly warmed the septum ha- deflected towards the right. 
The vomer ha- deflected toward- the right in order that the 



2*;s 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



turbinated bone may have room, and also to furnish uniform 
space. The septum in this case is bent and not broken. 

Fig. 81 is another form of deformity which I have occa- 
sionally observed. In this drawing we observe that the nasal 
cavities extend laterally nearly outside of the alveolar process. 
If we were to undertake to open the antrum through the 
cavities of the teeth we should drill into the floor of the nose. 
I have observed such cases. Having such a large space the 
turbinated bones have adjusted themselves to the best advan- 
tage. The septum also has adapted itself as best it can by 
deflecting toward the left side, having bent itself at its weakest 
part and opposite the enlarged turbinated bone. There is, 




Fig. 80. 

however, a large space upon the right side between the two 
turbinated bones. The thickness of the bone prevents its 
being bent by the pressure of air, and excessive development 
of the vomer has taken place upon that side as a substitute. 

Fig. 82 shows the turbinated bones upon both sides exces- 
sively and uniformly developed, the result of which is that 
the vomer is straight upon the left side, while the right half 
has been torn away, and by aspiration the air has drawn it 
slightly into the space between the two bones. 

Figs. 83 and 84 are drawings taken from frozen speci- 
mens in the Army Medical Museum at Washington, showing 
that the parts of fracture and deflection are situated between 
the turbinated bones. 



\\ I » I I I I II 






Another illustration, toshovi bou nature will adapt her 
self to abnormal conditions, is nicel) shown in b skull in m\ 
possession of a girl fourteen years of age, who died of con 
sumption. There is hardly a bone which goes t<> make up the 
Bkull, including the lower jaw, that does not Bho* 9tigmatn 
of degeneracy. The lefl inferior turbinated bone did not 
develop. A simple ridge is present where tin- bone Bhould be 
attached to the outer wall. The right inferior turbinated 
bone is excessively developed. The vomer has curved to the 
side where there is space and from the enlarged right turbi- 
nated bone. Although there is quite a bend, <»v. ing to the fact 
that the girl died at the age of fourtccn.it did not develop 
and lu'inl to the extent that it would had she lived. 




V 

Kit:. 81. 
Another case i^ that of a bone projecting .36 of an inch, 
(situated upon the right side of the vomer just midway between 
the superior and inferior turbinated bones) .7.") of an inch in 
length, I..'-" inch in from the nasal -pine, and .50 ^\' an 
inch from the posterior border, which is comparatively 
straight. The anterior part is slightly curved, hut perfectly 
Btraight .50 of an inch anterior to the commencement of the 
deformity. There is a slight groove upon the opposite side 
of the vomer to correspond to the line of projection. It 
stands just midway between the two turbinated hones. This 
is not a fracture, nor can we in any sense claim that the pro- 
jection is for the purpose of repairing a fracture. The length 
of this projection would also preclude such an idea. These 



270 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



projections vary from a mere ridge up to a projection .36 of 
an inch in width. It would seem that nature, being unable 
to develop the bone sufficiently to cany it far enough, built 
out a projection in order to complete its design. 

These projections were first mentioned by Langenbeck, 
who gave to them the name of exostoses. They were after- 
wards described by Theile, Harrison Allen and John Mac- 
kenzie. ''These projections," says Bosworth. *'are always 
found along the sutural lines of the septum, and consists in a 
more or less well-developed angular prominence or ridge, 
which, projecting into the nasal passage, acts to obstruct 
normal respiration." 




Fig. 82. 

This has not been my experience, as I have always found 
them situated upon the convex surface, and the greatest pro- 
jection being at the weakest point of the septum. As the 
greatest deformity may be located at any point between the 
anterior and posterior edges of the bone, we are liable to find 
the greatest point of projection on any part ot the septum, 
but they are always situated midway between the turbinated 
bones. This projection I believe to be due to irritation, the 
result of inhalation and exhalation. 

From the observation made it would seem that the deflec- 
tion of the vomer was due to a wise provision of nature. In 
its deviation to the right or left, with a decided depression 



i HE m vi>. PACE, i wn - \M. i i i i ii 



271 



always at ■ point where there ia the greatest , ometimes 

1,1 'I"' anterior part of the bone, and often in it- posterior 
pan; sometimes high up, and again lo* down, depending 
upon the location of the turbinated bone, with a rib of bone 
developed upon it- convex Burface, which I believe is nature's 
u.-i\ of supporting the deformed parts, My reason ia that it 
does not extend the entire length of the septum. It seeme to 
be also intended for a supernumerary turbinated bone. The 
deflection and the supernumerary turbinated bone are to com 
pensate for the space on either Bide of the nose. Just as the 
intelligence of the individual depends upon the amount of 
gray matter in the brain, and the graj matter depends upon 




Fig. 33. 

the number of lobes or convolutions, bo the warmth of air 
which is taken into the lungs depend- upon the amount of 
blood, the blood upon the amount of mucous membrane, and 
the mucous membrane upon the contortion of the bom 
the nose to produce Burface. If they are arrested upon one 
side, those upon the other enlarge or elongate, and thus make 
up for the deformity. I have also Bhown that when the 
inferior turbinated bone is entirely arrested the bend in the 
septum and projection seem to compensate for the loss. In 
neurotic- and degenerates, in many cases, the lungs and the 
chest wall- are undeveloped and very delicate. Nature 
requires that the air -hall he of a uniform temperature before 
it i- taken into the lungs. 

The deformities take place before puberty, and in a 



272 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



majority of cases before the sixth year. We know this to be 
the case, because the stamp of degeneracy is placed upon the 
face at this time. The arrest of development of the jaw takes 
place at the time the second teeth erupt, and the arrest of the 
nose and face shows that the individual possesses a face of 
that age. 

The width of the external nasal cavity varies consider- 
ably. In 2,000 cases, the greatest width was 1.25 of an inch: 
the smallest width was .75. The length from the nasal spine 
to the edge of the nasal bones was (greatest length) 1/54 and 
the smallest 1.20 of an inch. These skulls, however, are 
made up of Peruvians, stone-grave Indians, mound-builders, 




Fig. 84. 

cliff-dwellers, Hawaiians, etc., etc. In neurotics and degener- 
ates, when arrest of development of the face and nose had 
taken place, 1 found that the wudth measured . 50 to . 60 of an 
inch, and the length .80 to .90 of an inch. In these cases, if 
the turbinated bone developed uniformly, the vomer will be 
straight. If asymmetry exists, the vomer will be deflected 
to one side or the other, in wdiich case the bone, when covered 
with mucous membrane, will fill the cavity of the nose and 
mouth- breathing will result. 

Taking a general view of the nose, in many cases there is 
a want of harmony in its general outline. The nasal bones 
become arrested in their development, and the tip of the nose 
is turned up, owing to a normal or excessively developed 
cartilage. Another and very marked deformity is one in 



I ill HEAD, FACE, JAW8 AND TEETH 

which the nasal bone and cartilage ar< i\»l\ developed. 

The bone takes one angle and the cartilage another, produc 
ing a double n<>- This condition is very common among 
H( >rews There are, however, Americans frequently 
upon our streets who have developed nasal organs to such 
an extent that there is material enough for two fair-sized 
noses, In :i majority of these cases there is a total collapse 
ol tin- walls of the nose, and frequently mouth-breathing 

re-ult-. 

B8 illustrates Buch a case, although the nose is not 
nearly as large as these two I have just alluded to. This 
illustration, however, gives a fair idea of such In 

over -. » measurements of the nasal bones, the shortest was 

found to be .40, the longest L.65 of an inch in length. It 
will be seen that even the bones without the cartilage would 
make a fair-sized nose. These bones take different angles. It 
would seem that those which are the largest take the great- 
est angle. A form of deformity, which is more common than 
i< generally supposed, i> that in which the nose is deflected 
to the right or left. This deformity, however, i- often so 
i that it produces a marked asymmetry of the face, and 
often so slight as to he unnoticed by the average observer. 
There i- no doubt that it i- carried to the right or left by the 
cartilaginous septum, when only the -oft tissues are involved; 
l»ut when the bones of the nose are deformed, quite another 
condition exist-. Marked deflection, as well as other deform- 
ities y^' the nose, are not observed in early life, hut as the 
tact- develop- the deformity becomes more prominent, and 
at the age of puberty is well defined, although it doe- not 
reach it- full development until twenty-five or thirty year-. 
In most every instance the two lateral halve- of the face are 
asymmetrical, a- well a- the nasal hone-. The hone- of the 

nose develop upon one side and defied the lower border to 
the opposite side, where the bones are undeveloped. This 
ha- a tendency to deflect the cartilaginous septum in the same 
direction, which, in turn, exaggerates the deformity. Tin' 
author ha- observed noses in neurotics and degenerates 
deflected nearly 45 c from a normal position. It ha- been 



274 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

stated that these marked deflections are due to injury 
in utero or at birth. As the bones of the nose are unde- 
veloped at birth, and as marked deflection is not observed 
until later in life, it would seem out of place to bring forth 
such a theory. 

At birth the nasal cavities are not evenly developed. 
Nature tries to correct this defect. If one side is larger than 
the other, more air will pass through one side than the other. 
If the two sides are nearly even, the amount of air will be 
about uniformly distributed. 

Ziem has shown that if one nostril of a rabbit be perma- 
nently closed and the animal killed after it has attained its 
full growth, the nasal cavity of the affected side will be found 
to be undeveloped, and asymmetry of the face will have taken 
place. This is also the case when one side is undeveloped; 
the air passes through the opposite side and the passage 
becomes enlarged. A greater quantity of air passing through, 
a greater surface of mucous membrane is required to warm 
it. The turbinated bones become physiologically enlarged, 
owing to the stimulation of the air, and the vomer is carried 
to the weak side. The undeveloped condition of the nose 
and asymmetry of the face of animals, as demonstrated by 
Ziem, can be accounted for in no other way than a want of 
stimulation of air inhaled and exhaled. 

The septum ossifies much slower than the surrounding 
bone, and therefore it is more easily moved out of its normal 
position. At, or about the sixth year, the deformity is well 
established. The air stimulates a physiological development 
of the septum, and it bends toward the undeveloped side. It 
grows faster than the points of attachment, and as a result 
the septum, according to the law of mechanics, bends toward 
the smaller part. When inhalation takes place, the air pass- 
ing through the undeveloped passage, produces suction, thus 
drawing the bone toward that side; while upon the other 
hand, the large volume of air passing through the large nos- 
tril, forces it in the same direction. Thus, by aspiration and 
pressure, the thinner part of the bone is bent to the weaker 
side, which gives a uniform space for the pressure of air 



ill! Ill \l>. FACE, i \w - 4ND l II l II 

throughout the nose. The location of the deformity depends 

upon the m-\ 'iimu't r\ of the two Bides and tli<' thinness of the 
vomer. Wewill Frequently notice, by close examination of 
section of the vomer (as illustrated In Pigs. 82, 83 and 84, and 
also in plates I A. I Band I C, of u Atlas of Bead Sections," 
i'\ Win. Maoewin, M. D., just published), projection npon 
one Bide or the other, and sometimes upon both Bides, due t<> 
fracture or excessive development of bones tli.it they arc 
alwa\ b located between the turbinated bones. They are not 
always just in the center, but they arc qoI far from it. I 
believe these arc also the result of stimulation by exhalation 
or aspiration of air, producing a healthy physiological action 
at that point. 

When a Blight irritation of the mucous membrane takes 
place, as a result of cold, it thicken-. The child experiences 
difficulty in breathing. In the spasmodic effort to draw air 
into the lungs through the nose a vacuum is formed and the 
Beptum is developed and drawn to the point of least resistance, 
which would naturally be at a point between the turbinated 
bones. In this manner the Beptum take- the outline midway 
between the hones. The fracture very rarely extend- through 
the two halves of bone; only one Bide breaking, while the 
other is -imply bent. The fractured half being always upon 

the convex side lead- the author to believe that it is due toil) 

the thickening of the mucous membrane, (2) accumulation of 
moisture or purulent mucus, and (3 an excessive effort on tin- 
part of the patient to draw air through the nose. This being 
impossible the vomer is drawn into the space after partial 

ossification has taken place, and. as a result, fracture of that 
half and simple bending of the other halt". The edges ^\' the 
broken half are torn apart from the other half, producing a 
-pace between, which is eventually tilled up with hone cell-. 
This condition is not unlike the fracture of a green -tick. 
Sometime- it will he drawn to the right side in one place and 
to the left in another. Again, in the same manner, the two 
lateral halve- are separated their entire Length, a- illustrated 
in Fig. 72. Please note that there is a projection of the 
right half at a point midway between the right turbinated 



276 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

bones. This seems to the author to be the only natural thing, 
since, in many cases, the deflection and fracture only extends 
a short distance in the anterior middle, or posterior part of 
the vomer, while the bone will be perfectly straight anterior 
and posterior to the deformity. The shape of the deflection 
and fracture, it seems to me, can be accounted for in no other 
way. In order that fracture may take place, the vomer must 
have ossified partially or completely, which occurs at middle 
life; therefore injuries m utero or subsequently, before ossi- 
fication, are out of the question. If the turbinated bones are 
uniformly developed the vomer will, in most cases, remain 
quite or nearly straight. The force produced by drawing air 
will frequently separate the two halves and, occasionally, pro- 
duce one fracture upon one side, the other upon the other 
side. Not only are the cartilages of the nose brought in close 
relation to each other, but, occasionally, the force is so great 
that there is a total collapse of the outer bony walls and they 
are drawn toward the septum, making a groove upon either 
side, the nasal bones remaining perfectly flat at the upper 
edge. 

In this way, by taking a general view of the cavities and 
the nasal bones, we find a uniform distribution throughout 
the nasal cavity. 

Under such conditions the specialist should be exceedingly 
careful in regard to operations for the removal of excessive 
growths in the nose. 

The conclusions here reached may be stated as follows: 
The deviation of the nasal septum to one side or the other is 
the result of an unequal development of adjacent bony parts, 
more especially and directly of that of the turbinated bones. 
It depends largely, if not exclusively, upon the development 
and position of these latter. They, in turn, are dependent in 
great measure upon the development of the facial bones, 
which are modified as the facial angle increases and progna- 
thism is lost. The turbinated bones being, as it were, exostosed, 
not molded in many directions b} T adjacent parts, encroaching 
more irregularly upon the nasal cavity, as their origins are 
disturbed or dislocated. The freedom of these nasal passages 



I III HIM 



I \« I 



I \\\ 



\M» I I I I II 



for the the transit of respired sir is essential, :m< 1 the tendency 
of normal respiration is for both nostrils to share equally in 
this function. The natural consequence of this is thai the 
vomer, the ossification of which is incomplete until puberty, 
is deflected and occupies as nearly as possible, aa a rule, i 
midway position between the bony prominences on either 
Bide. The deflection of the septum is therefore a compensa 
tory arrangement for the evolutionary imperfections of the 
facial development it Is an incident of evolution. We fin/1 




! gf. 85 



it therefore most frequent in the higher races, while in the 
ancient Indians of this country and the negroes and others, as 
observed by Allen, other- and myself, the percentage of its 
occurrence is markedly decreased. 

Instability of tissue-building is to be expected in neurotics 
and degenerates. It is easy to see how with Buch an unstable 
bone tissue to build upon the mucous membrane of the nose 
can take on atrophy, hypertrophy and adenoid growths, 
resulting in mouth-breathing. 

It seems to be the accepted opinion of physicians at the 



278 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



present time that consumption is not an inherited disease, 
but that the patient inherits or acquires a weak constitution, 
and at certain periods, when the system is in proper con- 
dition, the bacilli find a habitat in the lungs and disease 
results. 

The human mouth is known to contain bacteria of almost 
every variety, and the author has taught students for the past 
ten years that it was his opinion that the mouth becomes the 
nidus for the accumulation of germs, and that when the sys- 




Fig. 86. 

tern becomes in the proper condition, these germs bring on 
not only tuberculosis, but pneumonia and affections of the 
throat, including lesions ranging all the way from simple sore 
throat to the most malignant form of diphtheria, and it seems 
to the author that these conditions may be avoided, to a cer- 
tain extent, by keeping the mouth in a healthy condition. 
Persons who are susceptible to these diseases, but more par 
ticularly consumption, are those who have inherited weak 
constitutions, such as neurotics and degenerates. Somatic 
signs are quite noticeable in most of these cases, and by early 
recognition, proper treatment with change of climate will, in 



I III III \l>. KAC1 






most oases, prolong life for manj years. These signs have 
already been spoken of indirectly, but as tin \ have a direct 
bearing upon deformity of the nose, it will not be out <•! place 

.11 the attention <>{ the reader to some of the deformit 
and one that play- an important part in the welfare of the 
patient: Total collapse of the outer walls of the nose is f re 
quently observed among neurotics and degenerates. This ifl 
associated with arrest of development of the bones of the I 
jaws, deformities of the dental arch, weak, contracted chest, 




round shoulders, husky voice, etc. In most cases of this 
description the nose is very long and thin. The nasal bones 
are excessively developed or arrested, with marked deflection 
of the septum. Frequently somi the different forms 

of nasal catarrh are present When the patient attempts to 
inhale air the outer walls are brought together and n 
breathing is impossible. The result is mouth-breathing, not 
only taking cold air into the lungs, but also diseased germs. 
The preceding illustrations Pigs. 85, 86, 87 and 88 are those 
of persons who possess all of the signs herein enumerated. 



280 



ETIOLOGY OE OSSEOUS DEFORMITIES 



These pictures are front views of those used in the chapter 
upon deformities of the face, and are intended to illustrate 
the long, slender nose. By comparing these with those repre- 
senting the side view, a very good idea of the thinness may 
be obtained. Three of these persons are now infected with 
tuberculous deposits, and the fourth will require the best of 
care to prevent infection. It is possible for persons to con- 
tract tuberculosis who do not present stigmata, but it is the 
experience of the writer that parents who have children 
possessing the somatic conditions noted in this chapter should 




Fig. 



pay particular attention to their early hygienic welfare in 



this regard. 



CHAPTER XXV, 

NEUROSES OF DEVELOPMENT OF THE ANTRUM. 

To describe the antrum is one of the most difficult tasks 
which the author has ever undertaken. Be has examined 
many skulls with this idea in view; but he has found that a 
description of one would not answer for another. Indeed, 
no two could be found to correspond, and their location, as 
will be observed, is not a certainty. The length, height, 
width and Location of the antrum is governed entirely by the 
shape of the tare and by the bones of the nose and of the 
superior maxilla', thus different nationalities would posa — 
antra of different size- and shapes. They seem t<> assume the 
greatest variation even in normal individuals, while stigmata 
o\ degeneracy are not only marked upon the external but also 
upon the internal surface, in neurotic- and degenerates. We 
cannot say, however, that a large maxilla will contain a large 
antrum or a small maxilla a small antrum: many things will 
have to be taken into consideration. Indeed, it would be 
impossible by Looking at a person to outline the position of 
the cavity. <ira\ says: kt The antrum is a large, triangular- 
shaped cavity; its apex, directed outward, i- formed by the 
malar process: it< base by the outer wall of the Dose. The 
author ha- examined skulls where the base of the triangle and 
apex were just the opposite. Indeed, from the author's 
experience, he would very much doubt the propriety <^ call- 
ing the shape of the antrum a triangle. He has observed 
antra almost square, with rounded corner-: others that 
would be very difficult to describe owing to the many deform- 
ities which they assume. Septa and bulging here and there 
with corresponding depressions would preclude any -uch 
description. We occasionally find the outer wall of the nose 
bending into the antrum, filling 25 to 33 per cent of its space. 
Occasionally, the outer walls ni the antrum will be very thin: 
in such cases the antrum will be large and well formed, but 
when thick, we usually find the antrum small and badly 

881 



282 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

deformed. If the orbits are not evenly located (which is very 
common) the vault of the antrum will be higher upon one side 
than upon the other. Sometimes the contour of the orbit 
will be changed so that in one antrum the outer wall will be 
the highest, and again the inner wall in another. This, how- 
ever, will depend to a great extent upon the general construc- 
tion of the osseous structure. 

Occasionally we will find the nasal cavities so large that 
they will extend nearly or quite to the outer alveolar borders. 
Again, the antrum will not be larger than the end of the 
little finger and will be located in the malar process. 

In cases of stigmata of degeneracy, as illustrated in 
u Arrest of Development of the Bones of the Face and Jaw," 
we would expect to find different shapes and positions of the 
antrum. Thus, in one case, the cavity was very small and 
resembled a crescent, with its concavity toward the nasal 
wall, its convexity toward the malar process. It was not 
large enough to admit the end of the little finger. In this 
case it did not extend as far laterally as the inferior orbital 
opening. The opposite side was similar in shape and 
extended just beyond this opening. Sometimes the antrum 
upon one side will be very long, while that of the other is 
very small; usually the nasal cavity will be ' carried over 
nearly one-half of its size to the side of the smallest antrum. 
We sometimes find soft, cancellated bone extending the 
alveolar process into and filling the antrum, leaving a num- 
ber of small openings or sinuses which resemble the ethmoidal 
cells. In these cases the contour of the face is also very 
much disfigured; a drill passed through the alveoli of the first 
and second bicuspids would not reach an opening. 

Bosworth says, on page 75, in reference to the develop- 
ment of the antrum (Fig. 89): "Or again, deficient absorp- 
tion of the alveolar process in foetal life may produce marked 
encroachment upon the lower portion of the cavity. On the 
other hand, the cavity may be abnormally enlarged from 
excessive absorption of osseous tissue in foetal life down- 
ward into the alveolar process or forward,, as the result of 
which the antrum may extend between the floor of the nose 



Ill \l>. I \( I 



\ND I I I 1 II 






:ui.l the bard palate, as Been in Fig. DO, or if ma} extend up 
into tin- malar bone or into the frontal, as the result oi ■ 
similar process of absorption in this direction.' 1 

As the alveolar process is never developed in foetal life, nor 
to the extent as represented here, until all the permanent teeth 
are in place, winch would be at about the tenth to the twelfth 
\ ear, absorption oould not take the place of something that did 
not exist Again, there Is not room for the development of 
the first and second Bet of teeth. 

This drawing (Big. n, .»i illustrates a jaw and nasal bone of 
■ person, certainly in later life, after all the teeth had been 
removed and absorption <>f the externa] Burface of the alve- 




Fig 

olar process had been going on for many year-. The round- 
ness of the alveolar process, the ridge of bone In the vault 
and the vault itself, indicate this to be the case. An alveolar 
process the size and shape illustrated here could only develop 

with the second Bet of teeth. It will he observed that the 
left antrum i- unusually large; that it extend- up to and 
encroaches upon the left orbital cavity and quite a distance 
along the inner border. It also encroaches upon the left 
nasal cavity and downward into the alveolar process. The 
right antrum is very small, a- a result of which the alveolar 
process is very large ami extends quite a distance into tin- floor 
of the nose. To compensate for this want of harmony in the 



284 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



development of the antrum, the turbinated bones have become 
enlarged, and although the nasal cavities have developed con- 
siderably to the right of the face, all the bones of the nose 
have so arranged themselves that there are uniform spaces 
between them. If the teeth in this individual remain the 
usual number of years (this drawing represents a person 
from forty-five to sixty-five years of age) the only absorption 
that could possibly take place would be at the outer border of 
the alveoli. 

Fig. 90 not only shows the antra extending toward the 
median line upon both sides, encroaching upon the nasal 
cavity, but there are also ridges of bone and septa extend- 




Fig. 90. 



ing through the cavity. This is likewise the case in Fig. 89. 
To say that absorption of tissue can take place and produce 
these large and abnormal cavities encroaching upon other 
cavities, developing these to one side, does not, with our 
knowledge of absorption and deposition of bone, account for 
these conditions. That the building up of abnormal tissues 
went on at the time of the original formation and shaping of 
these cavities there can be no question, and until a better 
reason is given it must be said that it is due to a want of 
balance in nerve function, which presides oyer development, 
or they are stigmata of degeneracy. 



i hi in: \i\ i \< i . .1 \w - wi» i i i i ii 

The fellow in b oases are given to -how the different shapes 
and looatioDfl of the Antrum: 

Cas] I. Ls that of a prostitute. Width of dental arch, 
2.25. The antrum upon the right Bide extends back as far as 
the third molar, forward to the canine eminence; from the 
lower border of the alveolar process to the floor of the orbit, 
the ea\ it\ was triangular in Bhape; the apex being downward 
at tli«' alveolar process; the base being the floor of the orbit. 
Its length at the lower part was 1.50; at the upper, L.75; 
height at the posterior part. L.75; anterior part, I 
width below, .25; at the upper, .62 of an inch. The cavity 
was divide. 1 into two separate parts i»\ a septum of bone .50 

of an inch in height; another Beptum of hone extended 
horizontally alone- the inner Bide opposite the inferior orbital 

ridge. The left side of the superior maxilla was very much 

arrested in its development, with a marked protrusion of the 

alveolar process and teeth to make a respectable dental arch 

rrespondtothat of the other side. The antrum extended 

from the third molar forward to the second bicuspid. The 
length of the antrum at its lowest part measured l: upper 
part. L.50; height at the anterior part. L.24; at the posterior 
part, L.60; width at lower border, .36; at upper holder. .50. 
The apex in this case was located at thelnalar process, its 
base being the outer wall of the nose. A drill passed into 
the cavity of the first bicuspid upon the right side would 
penetrate only one-half of the antrum, while it would require 
an opening at the second molar to drain the posterior cavity. 
In either case the drill would have to travel only about .25 
an inch from its outer border. If a drill were carried into 
the antrum at the .-interior root of the first permanent molar 
upon the left side, it would have to pass .75 of an inch to 
reach it. 

Case [I.— Is that of an Irishman, a degenerate and epi- 
leptic. Width of dental arch. 2.75; vault is .84 in height; 
jawa are very Large and massive. The antrum upon the 
right Bide extends from the posterior surface oi the third 
molar forward at lower border to the anterior root of the first 
permanent molar: at the upper border, on a line with canine 



286 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

eminence. Over the root of the second bicuspid there is a very 
marked depression, showing that the walls of the antrum 
unite at that point. The cavity is almost square, as will be 
seen by the figure; length of lower border, 1.12 of an inch; 
upper border, 1.52 of an inch; height of anterior part, 1.25; 
posterior, 1.20; width below, .75; above, .80. To reach the 
antrum at the second bicuspid the drill would have to travel 
1.25 from the lower border of the alveolar process; at the 
anterior root of the first molar, .75 from lower border. The 
antrum upon the left side extended .50 of an inch back of the 
second molar (the third molar not being present) forward to 
a point over the root of the second bicuspid; the upper part 
extended as far as the canine eminence. Length at lower 
border, 1.25; upper, 1.75; height anterior, .7; posterior, 
1.25; width, .75; lower border, .78; upper border, .80. To 
reach the antrum at second bicuspid the drill would have to 
pass 1, with difficulty in reaching it; at anterior root of first 
molar, .84. Both cavities are free from septa. 

Case III.— Is that of a criminal. The third molar was 
never present upon the right side. The antrum, therefore, 
extended .50 beyond the second molar forward as far as the 
anterior root of the first permanent molar, on the upper bor- 
der to a point above the canine eminence. This cavity pos- 
sesses a very peculiar shape, as will be noticed in the figure. 
Length of the lower border, 1; upper, 1.50; height anterior, 
1; posterior, 1.25; width lower, .50; upper, .84; triangular 
in different directions. First apex at outer surface of malar 
bone; base outer plate of the nose; second apex anterior near 
the nose, and base toward posterior surface. The roots of the 
first and second molars penetrate the antrum as in drawing. 
The antrum could only be reached by going through the 
outer plate of the alveolar process at the first permanent molar. 
The antrum upon the left side extended from the posterior 
surface of the second molar forward to the first permanent 
molar. Length of lower border, 1.25; upper, 1.75; height 
anterior, .75; posterior, 1.25; width lower, .50; upper, .60. 
This was a very remarkable cavity. The roots of the 
second and third molars penetrated the floor of the cavity; an 



1 111 iik \i>. FACE, i \\\ - \m» 1 1 i i ii 

• 98 had appeared upon the baocal roots of the first molar, 
u it limit in j ii rv to the floor of the antrum. The outer wall of 
the nose had bulged into the antrum its entire length and 
w id tli from the lower turbinated bone to the floor of the i 
The inner and outer walls of the antrum bad become united 
at about its middle bj a Beptum, making two diatincl 
cavities. 

I \-i IV 1- thai <>f a pauper. The antrum upon the 
right Bide extended .50 of an inch beyond tin* third molar; 

rard at lower border as far as the second bicuspid; at 
upper border to a point over the canine eminence. The apex 
i>\ the triangle in this case is located at tin- junction of the 
wall i>i tli*- nose ami floor of the orbits. The base was formed 
by the outer surface, tin- malar process; a ridge, dividing tin* 
anterior part of the ant ruin into two cavities, extends from the 
floor of the orbit down about half the depth of the antrum at 
■ point ^\ exit of the inferior orbital nerve and artery. The 
outer wall i^' the nose curves into the antrum, filling it about 
one-third full. It will be seen, therefore, that the cavity is 
very irregular in shape. Its length at the lower border is 
1.12; upper border. l.-*'. v : height, anterior part. .7.".: pos- 
terior, L25; width lower border, .36; upper, 1 inch. The 
molar teeth extend into the floor of the cavity. Arrest 
<»f development of the maxillary bone upon the left aide 
necessarily causes the antrum to be much -mailer than upon 
the right side. Like the right antrum it extend- .60 of an 
inch beyond the molar: its lower border extends forward to 
the anterior root of the first permanent molar, its upper bor- 
der to a point over thecuspid tooth. Length of lower border, 
1: upper, L.25; height anterior. .75; posterior, L.12; width 
Lower edge, .25; upper. .92. 'The palatine root- of the first 
and second molar- penetrate the floor of the antrum. 

Case V. —Is that of a prostitute. The right antrum is 
very .-mall and extends back to the posterior surface of the 
second molar, the third molar not being present. From the 
lower border of the antrum to the lower border of the alveolar 
process is .75 of an inch: the roots of the teeth therefon 
not reach within .'2~> of the floor of the cavity. The length 



2S8 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

of the lower border is. 75; upper, 1.12; height of the antrum, 
.60; posterior, 1; width of lower, .25; upper, 1. A sep- 
tum extends the entire length of the outer and inner 
walls, except a space about the size of a lead-pencil, dividing 
the antrum into almost two distinct cavities. The left antrum 
extends to the posterior border of the third molar; the cavity 
is slightly larger than the other, although the alveolar pro- 
cess is just as large, and therefore, the anterior border, so far 
as the teeth are concerned, has no relation to this. The length 
of lower border, .86; of the upper, 1.22; height of antrum, 
posterior, .62; anterior, 1; width, .28; upper, 1.02. This 
cavity contains a number of septa running in every direction. 
The nasal bone bends inward, and in every way shows stig- 
mata of degeneracy. If a drill were to carried into the antrum 
through the roots of the bicuspids it would have to travel .60 
of an inch, and then would not reach the lowest point. We 
are not warranted in making openings into the antrum through 
the root canals of the molars, because they rarely incline in 
that direction. The drill would pass either into the floor of 
the nose or out at the cheek. 

The following illustrations, here referred to, show stig- 
mata of the antra and the difficulty of always reaching the 
floor of the antrum by passing a drill up through the alve- 
olus for the purpose of drainage. Fig. 77 illustrates the left 
antrum excessively developed. The base of the cavity located 
at the floor of the orbit, the apex near the borders of the 
alveolar process, extends quite a distance toward the median 
line and under the nasal cavity. It even encroaches upon the 
left nasal cavity at its upper border. A drill would pass 
without trouble into this cavity through the palatine or even 
buccal roots of any of the molar teeth. Quite a different state 
of things is noticed upon the right side. The nasal cavity is 
carried over and occupies the space where the antrum should 
be located. The antrum is very small upon the inner surface 
of the malar process under the eye. A drill passed through 
the alveolus would certainly enter the floor of the orbit. Fig. 78 
also shows both antra located in such a position that the 
drill passing through the alveoli would not penetrate, but in 



I ill ii I \i>. FACE, JAWS w I' I i i i ii 

both oases the floors of the nasal cavities would be punctured. 
The left antrum in Fig. 79 is almost entirely obliterated. 

Stigmata arc not only Been in the antra, '"it also throughout 

a 

the nasal bones and ethmoidal cells. 

Ii is possible to reach both antra by drilling through the 
alveoli, !>ut it could not be accomplished without difficulty. 
The cross section of Fig. NH was taken bo far forward that a 
description of the antra is out of the question. 

Fig. Bl Bhows the antra bo small as to be almost obliter 
ated. The nasal cavities, however, are bo large that the 
floors of these cavities would be punctured if a drill was 
passed through the alveoli. 

Some years ago I recorded a in-*' where a patient, in 
having an opening drilled through the cavity of the Becond 
bicuspid to relieve the antrum, the drill passed into the floor 
of the nose. At that time it occurred to me that there Was 
gross ignorance on the part of the operator as to the locution 
of tin' antrum. My attention has since been called to several 
cases by specialists. 

In my examination of skulls for the purpose of preparing 
this chapter, I have discovered Borne seven or eight c 
where the floor of the nose was bo wide and the facial hone- 
so deformed that the long axis of the root- were directed into 
the floorof the nose. In each case the floor of the nose would 

he perforated were the operator to drill through the palatine 

buccal roots of the tir>t or second molar-. Again, I have 
frequently observed arrest of development of the maxillary 
bone on a line with the alas of the nose, when the alveolar 

process (in order that the teeth might antagonize with the 
lower teeth) extended outward to such an extent that the 
apices of the root- of the bicuspids would point entirely out- 
Bide of the line «>f the antrum. It will be seen, there: 
that the alveoli are not a reliable route by which to reach the 
lowest point in the floor of the antrum, nor is the operator 
sure of reaching it at all. It is easy to see how in a very few 
cases the development of the antrum and nasal cavities might 
he so arranged, together with the thinness of the alveolar 
process, that the roots of the teeth may penetrate the floor 



290 



ETIOLOGY OF 08SEOUS DEFORMITIES OF 



of the antrum, as illustrated in Fig. 91. These cases, how- 
ever, are very rare, as we shall see later. Again, we can 
also observe how in most cases, owing to the thickness of the 
alveolar walls and the position of the antrum, the roots of the 
teeth will not reach it. As will be noticed it is very rarely 
and almost never the case that the roots of the first and second 
bicuspids enter the floor of the antrum. The roots of the first 
permanent molar in its relation to the antrum are such that 
it is almost impossible to penetrate them. 

Of the 11,000 skulls examined for deformities only 3,000 




a— 



Fig. 91. 



were in a broken condition, so that the antra could be exam- 
ined, making 6,000 antra in all. Of this number 1,274, or 
about 21 per cent, had abscessed molar teeth. Of this num- 
ber 76, or about 6 per cent, extended into and apparently 
discharged into the antrum. Taking into consideration the 
fact that specialists were unknown among the people w T hose 
skulls were examined, we would expect to find a larger per- 
centage of abscessed cavities than at the present day, which 
has been shown by the examination of both skulls and patients. 
Septa were found in 963 cases. These ranged all the way 
from a simple ridge running along the floor to a partition 
extending two-thirds the height of the cavity. Again, several 



I III MINI. I M I . .1 \W - \M. I I I I I! 






septa occurred in all directions, which gave the appearance of 
of ethmoidal cells extending throughout the entire cai ity. 

In the treatment of i - of pulpless teeth, in oonnec 

tion with the superior molars, In the past twenty-two y\ 
only three cases oi diseased antrum were noticed, making 
less than three per cent of diseased antrum. 

Dr. M. 11. Fletcher found in 224 cases of pulplesa molar 
teeth, treated by him, only one case of pus In the antrum. 
These statements, therefore, would Bhow thai antral difficul 
ties are very rarely connected with the teeth. The author is 
of the opinion thai mosl cases of diseased antrum seek the 
specialist because mosl cases arc connected with the nasal 
lesion, and therefore the dental Burgeon sees only a small 
percentage of actual cases. The author, therefore, is of the 
opinion thai disease of the antrum is very rarely due to dis- 
eases of the teeth, and thai like diseases of the mucous mem 
brane of the nose; the mucous membrane of the antra is to 
a great extent the result of -first, a very abnormal develop- 
ment of the osseous 33 stem, and, a oond, of improper tonicity 
i)f the nen ous system acting upon a badly developed mucous 
membrane. 

My experience has been that disease of the antrum is 
most often observed in persons who have Keen exposed to 
cold weather, and that both sides are more or less affected. 
This was a common occurrence with the epidemic of la 
grippe. If only one side is involved, the other frequently is 
or has been at a previous time. In the large number of 
skulls examined, the floor of the antrum was found to be nearly 
on a level with the line of the alveolar process as far a-> the 
.•interior roots of the first molar. It then curves upward and 
forward, terminating at a point above the apex of the root of 
the cuspid tooth. That being the case, a drill passed through 
the alveoli of the first and second bicU8pid would reach a 
point quite a distance above the floor of the antrum. From 
what has been said in regard to the shape and location of the 
antrum, it will be seen that the lowest point, and always 
safest locality to puncture the antrum, i- at a location just 
between the roots of the first permanent molar and the root 



292 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

of the second bicuspid. The opening should be made with 
a drill directed backward and inward. This part is nearly 
always on a level with the floor of the antrum, and the outer 
wall is very thin at that point. The patient should be 
requested to lie first upon the back and then upon the face. 
Should there be any septa the fluid will in this way be easily 
drained. 

Since this was written Dr. M. H. Fletcher, of Cincinnati, 
Ohio, read the paper "Some Suggestions as to the Relation 
of the Teeth to Empyema of the Maxillary Sinus," before 
the Section on Oral and Dental Surgery of the American 
Medical Association, held in Milwaukee, Wisconsin, June 1, 
1893. I consider this contribution of so much importance 
that I take the liberty to quote his results: 

"The summing up or rationale, then, of the evidence here- 
with seems to be, first, that the anatomical relations between 
the teeth and the antrum are not generally understood, since 
the sections here shown give evidence of much more can- 
cellous bone than is usually considered to exist. 

' ' Second. Small septa are present in a large per cent of 
cases, and these septa or ridges have no direct relation to the 
position of the teeth. 

' ' Third. Statistics seem to show that a very small per cent 
of abscessed teeth have any connection whatever with the 
antrum; this per cent probably not being over seven to ten. 

"Fourth. The evidence seems to indicate that the protru- 
sion of the teeth into the cavity is very largely the exception 
instead of the rule, and that if they do protrude, it is not evi- 
dence that an alveolar abscess would break there, since these 
tubercles are usually formed of dense, hard bone. 

' ' Fifth. A number of cases have been found where there is 
a perforation of the bone by the apices of the teeth and no 
protrusion; but that these apices are simply covered with 
mucous membrane, thereby the teeth may be affected by 
inflammation of the antrum, causing their death and loss or 
a continuance of the trouble in the antrum by their presence 
in consequence of this special feature of the anatomy, and 
that pulpless and inflamed teeth are thought to be the usual 



I III HI \1». I \< I , I \N 8 \M' I I I I II 

cause of antral trouble, where the reverse is often probably 
the case. 

• Si That seeminglj the best plaoe to perforate the 
antrum of Highmore tor pas, is between tin- apices "t the 
second * » • « - » i — j > i . t and first molar. M 

It will therefore be observed thai the experience and oon 
elusion I*! Dr. Fletcher air not unlike my own. Nov. '•*. 
L893, I received the following letter from Dr. Fletcher: 

"Since writing tin- paper, I have examined an addi- 
tional MX) skulls, ami find tli<' figures changed in regard 
to the per cent ^\ abscessed molar- which arc connected 
with the antrum. In 500 skulls (making L,000 antra I 
find 252 upper molars abscessed, making twenty-five per 

cent of antra which have abscesses in this locality, or 
c\cr\ fourth antrum. This per cent is probably -mailer 
than it should be, since many teeth were lost and the alveolar 
process absorbed away, and undoubtedly some of these !<>-t 
teeth have been abscessed. Out of these 252 possible cases, 
perforation into the antrum was found only twelve time-: 
thus showing over four and one-half per cent, or about one 
in every twenty-one of the abscessed teeth in this locality, 
which are connected with the antrum.'" 

The extended examination- and observations made by Dr. 
Fletcher and the author present similar results. 



CHAPTER XXVI. 

NEUROSES OF DEVELOPMENT OF THE BONES OF 
THE ORBITS. 

In the development of the osseous system the orbital 
cavities take different shapes and positions in neurotics and 
degenerates. Sometimes they are placed near each other, 
and, again, far apart. Thus, in a measurement of 2,600 
skulls, from the junction of the lachrymal and frontal bones 
of one orbital cavity to the same point on the other, the near- 
est measurement was .84 of an inch, and the greatest width 
was 1.25, thus showing that the sight in those farther apart 
possess the greatest field of vision. In degenerates especi- 
ally, the orbital cavities deviate from a horizontal line. In 
some cases the lateral halves of the face will be normal, while 
one orbit will be located higher than the other. This is illus- 
trated in Fig. 64. Again, the face would present the appear- 
ance of having been made in two halves and placed together, so 
that one half would be higher than the other. The author has 
observed quite a number of such cases. This would cause the 
orbital cavity to be situated higher on one side than the other. 
The depth of the orbits also varies not only in different skulls, 
but also in the same skull. Thus from the supra-orbital notch 
to the optic foramen is 1.70 of an inch to 1. 12 inches in different 
skulls, and from .12 to .18 of an inch in same skull. The 
shallowness of some of these skulls would indicate neuroses 
as well as degeneracy. 

Dr. G. Frank Lydston, in speaking of orbital deformities, 
says:* "This is well shown by comparison with some of the 
other types already described, the measurements being If 
inches from the upper margin of the orbit to the optic fora- 
men, while in the Indian and negro skulls, in this series, the 
orbits measure two inches in depth. The outer walls of the 
orbits encroach upon the cavities, giving a still more marked 

* The Alienist and Neurologist^ Oct. 1891. 

294 



till III \l>. I \« I . I \\\ - \\l. 1 1 I I II 

appearance of shallowness. The form and index of the orbit 
ire given considerable weight bj anthropologists as a< 
rion of racial type. 

••It la claimed bj Dr. Lydston, and verified bj him 
i>\ comparative Btudies of orbital development, that the 
form of the orbit is even of greater importance as bear 
ing upon the question of degeneracy of type. That 
marked variation of the form and measurements of the orbit 
is incidental to differentiation, is seen i»\ observation of the 
anthropoids. There is a striking difference between the mem- 
bers (>i the Simian group in this respect, and a -till greater 
difference, is noticeable between the rimiada and lemuridw." 
The shallowness and obliquity oi the orbits is Btrikingly 
similar to the characters observed in the gorilla and chim- 
panzee, which arc quite different from those noted in the 
orangs. The outer surface of the orbits not only differs in 
shape in different Bkulls, but they also differ from each other 
in the same Bkull. Thus, the cavity is supposed to be quad- 
rilateral in shape. The angles, however, differ in deg 
some are nearly round, other- square with round corner-; 
-till others in which the lower outer corner extends outward 
and downward quite a little beyond the inner corner. The 
walls of the inner part of the orbit are m»t infrequently 
deformed or twisted out of shape. It is easy to Bee how, 
when the maxillary hones and antra, the ethmoidal hones and 
cells the frontal lobes of the brain) are deformed, the walls 
of the orbit will correspond to these deformities. None of 
the special organs of sense are so liable to become affected in 
cases of neuroses and degeneracy a- the eye-, and these 
deformities are to be found more among the neurotic- and 
degenerates than any other class of individual-. Quite a 
difference was also noticed in the -ize. shape and position of 
the optic foramen and fissure. These, however, were not 
studied with sufficient intention to give scientific descriptions 
of their different positions and shapes. The author will only 
say that owing to stigmata of degeneracy of surrounding parts 
it would be natural to expect abnormal development in con 
nection with these cavities. 



29B ETIOLOGY OF OSSEOUS DEFORMITIES OF 

OCULAR AFFECTIONS ASCRIBABLE TO DEFORMITY OF THE 

ORBITS. 

That orbital deformities have a causal relation to certain 
ocular affections cannot be well denied. Among the more 
frequent conditions arising from or directly traceable to inflam- 
mation of the orbits may be mentioned exophthalmus. or 
protrusion of the eyeball from the orbit; slighter degrees 
of this affection are only perceptible in case the trouble lies 
in the one eye, when, by comparison, a diagnosis is readily 
obtained. In higher degrees the difference is quite percept- 
ible even to the casual observer. In diagnosticating this con- 
dition, a nice point to remember is that ordinarily if a straight- 
edge be applied vertically to the supra and infra-orbital 
margins it comes in contact only with the apex of the cornea, 
but does not compress it. The two chief predisposing fac- 
tors of exophthalmus are: (1) Increased orbital tissue: (2) 
diminution of the orbital capacity; both of which conditions 
are regulated by orbital deformity as a result of degeneracy. 
In the consideration of the question of orbital deformities we 
must not lose sight of the fact that the conformation and size 
of the orbit keep pace w T ith the enlargement of the eyeball. 
Thus, if the eyeball is retarded in growth from any cause, 
or, if indeed, enucleation becomes necessary in early life, the 
orbital dimensions are necessarily narrowed and contracted, 
so that if it becomes requisite in later life to adjust an arti- 
ficial eye, we find it impossible to insert an eye approximating 
its fellow in size. Furthermore, we should also note that the 
position of the eyeball in the orbit varies in different individ- 
uals, and that there may be a difference in the two eyes of the 
same individual: this being associated with an asymmetrical 
face, which, in turn, may be directly traceable to degeneracy. 
These conditions usually entail a difference in the refraction 
of the eyes, and in such cases the exophthalmus may be only 
apparent, as the myopic eye is usually larger, and, therefore, 
might simulate an exophthalmus. 

Another ocular affection that is prone to ensue as a result 
of orbital deformity is optic neuritis, which probably arises 



I III 



LWfi \M' I I I I 1 1 



from pressure upon the nerve at the Bite of the opt c 
foramen. 

\ On Graefe was the first to point out this fact, and since 
his time mani oures haw been recorded. Nettleship has 
recorded oases of post papillitic atrophy as a sequence of 
congenital hyperostosis. 

Among other frequent ocular malformations consequent 
upon degeneracy ma\ be mentioned coloboma iridis, and, 
rarely, coloboma of the choroid, lens and Lids. Coloboma of 
the iii- is explicable as a sequence of coloboma of the choroid. 
Inasmuch as the iris projects from the anterior border of the 
choroid at a time when the foetal ocular fissure is closed, it 
has no fissure; but if the choroid experiences abnormal develop- 
ment at the retina] fissure, the deformity maybe imparted to 
the iris, and the latter fails to develop at the abnormal area. 
and is lacking at this site, constituting coloboma of the iris. 

Anophthalmia, microphthalmos and buphthalmus are 
likewise conditions thai arc seen at times arising from orbital 
deformity. The results of degeneracy implicating the ocular 
development are sometimes peculiarly striking. Thus, we 
have retinitis pigmentosa, which Leber has cited as persistent 
throughout generations. ( Congenital aphakia, or total absence 
of both lenses, has been noted. Typical albinoism with con- 
genitally displaced lenses, tremulous irides, etc., is a some- 
what frequent result of degeneracy. 

Double amiridia, or absence of both irides, has been like- 
wise noted, as well as cases of sclerectasia poscterior. The 
ocular affections which are most typically illustrative of the 
effects of degeneracy, manifesting itself in the form of def< 
of orbital contour, and those too that are most frequent, may 
be grouped under the general heading of refractive errors, 
which are of variable degree and type. Thus, as a result of a 
contracted eyeball antero posteriorly, we have hyperopia, a 
condition of the refraction in which parallel ray- of light 
impinging upon the eye are not focused upon the retina, hut 
behind the same, this being ordinarily ascribable to an axial 
defect. Precisely opposite in its character- i- the short- 
sighted eve, which ordinarily arises from an elongated antero- 



298 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

posterior axis, which causes an increased rcfractivity of the 
eve whereby parallel rays are focused in front of the retina 
instead of upon it, as they are in the emmetropic or normal 
eye. Combinations of the above types are found in conjunc- 
tion with the normal or emmetropic eye, constituting differ- 
ent types of astigmatism, so that we find these defects as a 
natural consequence of degeneracy entailing orbital deformity, 
and while we recognize that degeneracy is not necessarily the 
rule as a predisposing cause of such conditions of the refrac- 
tion, yet the} r are sufficiently frequent to make it highly sug- 
gestive. The prevalence of such a large number of young 
people wearing glasses in some of our Eastern cities has led 
to the common remark that it denoted intellectual ability. 
The author would suggest that it denotes physical defects 
often due to neuroses and degeneracy. 

Perhaps there is no lesion so common, as the result of 
degeneracy of the osseous system in its relation to the eyes, as 
stenosis of the naso-lachrymal duct. Occasionally only one 
side will become involved, and again both sides. These 
cases are more noticeable where there is arrest of develop- 
ment of the bones of the face, as illustrated in Fig. 80. In 
this class the bridge of the nose is undeveloped, as well as all 
the other bones of the face which are on a level with the bridge 
of the nose, the result of which is one or both canals are parti- 
ally or nearly undeveloped. The same condition is frequently 
found where the bridge of the nose is very narrow and high, 
as illustrated in Fig. TO. In such cases degeneracy of the 
bones of the face is even more noticeable than in the other 
cases. The results of such deformities are familiar to all 
specialists. 

In an examination of 207 patients, taken as they came, 
the following deformities of the face were found: 



1 III III \l>. I \« I . I \\\ - \M» I I I I II 

lOl u I'll I 'i:Mi i ii - in i hi JAW8 O] i in Bl IND. 





& 


3 

c 


— . 




-.ion 
per 


si 

— 


& . 

> 


1 




-c 




M 

1 




- 
- 




LO 


18 


» 










• • 




16 


L6 


i:. 


- 






11 


LO 


P nt. 










- 








>.- 



« tot 

In twenty-seven examinations <>t congenitally blind 
patient-, all possessed either deformities of tin- bead, face, 
jaws or teeth. 



CHAPTER XXVII. 

NEUROSES OF DEVELOPMENT OF THE BONES OF 

THE EAE. 

It is scarcely necessary to refer to the fact that aural affec- 
tions are frequently a result of degeneracy, exhibiting itself 
under the various forms of deformity implicating the audi- 
tory apparatus. Thus we have total absence of the external 
ear. together with an embryonic internal ear. The mere fact 
of the exceedingly primitive structure of the internal audi- 
tory mechanism necessitates abnormal or defective hearing 
power as a consequence. It is to this fact that many cases of 
congential deaf-mutism owe their origin, inasmuch as the 
auditory mechanism is not in a condition to appreciate sound, 
even though the individual may not have been born deaf, the 
state of deaf-mutism from inability to appreciate sound and 
the whole auditory apparatus subsequently degenerates. Of 
course, a mental defect is sometimes superadded, thus aggra- 
vating the case. 

As in the case of the congenitally blind and persons who 
become blind early in life, the author has so far been unable 
to study particular cases of deaf-mutism, owing to the fact 
that it is so difficult in this country to obtain skulls, the his- 
tory of which is known. 

Speaking upon general principles, and what is known 
about the congenitally deformed ears, it stands to reason that 
if deformities of the head, face, jaws, nose, antra, vaults, etc., 
are common in neurotics and degenerates, stigmata of the 
bones of the ear certainly must occasionally take place. 
Taking into consideration the complicated structure of which 
the bone and sundry parts of the ear are composed, lesions of 
the ear must in many cases be attributed to such deformities. 
In an examination of 1,935 patients, taken as they come, the 
following deformities of the jaws were observed: 



3J0 



1 111 III VI'. I M I . JAWfl \M> I M 1 II 

rOTAl DETORMITIE8 IN TH1 JAWS Ol l m i»i \i \M» i»i mi-.. 





& 




o . 


1 Acr 


per 


lit. 






/ 


JZ 

- - 


1111 


M 

1 


- 


L97 
108 


11 
51 


116 


241 


01 


li:. 


LOS 


M 






901 








U8 


L69 


L92 




1 1 3 




cm. 




15.7 


i.; 


in.:. 


21.7 


8 




in. » 


8 



I u •? palate. 

In an examination of 14:'» cases of congenital deaf mates 
93 per cent of them possessed deformities of the head, face, 
jaws and teeth. 



CHAPTER XXVIII. 

NEUROSES OF DEVELOPMENT OF JAWS OF 
APPARENTLY NORMAL INDIVIDUALS. 

That the deformities of the iaws of the neurotics and deo-en- 
erates as found in our asylums may be compared with those 
whom we meet in every-day life, the author examined the 
mouths of 1,000 school children over twelve years of age and 
1,000 adults, patients and friends, with the following results: 

TOTAL DEFORMITIES IN THE JAWS OF CHILDREN. 







7s 
S 




o 


Protrusion 
Upper 
Jaw. 


a 13 


•a 


tial 

Shaped 

ch. 




£ — 

CO 


o 




o 
55 


5 


!^ 




^ 


&>< 


T3 Xi »r 
rt CO < 


396 


M 


303 


11 


3 


5 


26 


5 


18 


12 


13 


604 


F 


463 


8 


4 


o 


30 


6 


43 


21 


17 


1000 




766 


19 


7 


7 


56 


11 


61 


33 


30 


Per c 


ent. 


76 


1 . 9 


.7 


.7 


5.6 


1.1 


6.1 


3.3 


3.0 



TOTAL DEFORMITIES IN THE JAWS OF ADULTS. 









£ 




-d 


T3 


u 
















3 




_ £" . 


0, 




u 


OJ 






S 


OJ 




53 J3 


rt J= -d 


. J3 J3 


— -c 


rt 13 


! -O 






b/o 


jd 


■ZJ 'X 


'g 'X 


T3 


'.S T3 


"S 'S 


1 


OJ 
CO 


o 




"53 SH 

s c 


r< 


Oh 


CO 


CO 


1- ri 
« CO 


g eS 


284 


M 


211 


9 


48 


16 


16 


10 


14 


27 


9 


716 


F 


403 


23 


62 


19 


56 


8 


29 


24 


25 


1000 




614 


32 


110 


35 


7° 


18 


43 


51 


34 


Per c 


ent. 


61 


3.2 


11.0 


3.5 


7.2 


1.8 


. 4.3 


5.1 


3.4 



302 



I III III M'. I \« I . JAWS \M> I I I I II 

lii comparing the figures in the i \\ » » tables it will i>- 
that there is 15 per cent more deformities ingrown people 
than in children. This can be accounted for in three ways: 
ih Thai as people grovi older it is possible for some oi the 
Blight forms of irregularities of the t » *t 1 1 to become more 
prominent, owing to the movement and permanent arrange 
ment of the teeth later in life. (2) As the examination of the 
mouths of the children was made some years ago, it is possi 
ble that the eye was not as well trained as it is at the present 
time. It will also account for the difference in the classifica- 
tion of deformities. (3) Part of these examinations arc those 
of my patients, which would also swell the list of deformities. 
The percentage of deformities, however, compares \ r erj fa 
ably with the percentage of deformities of the face. Taken as 
a whole they give an approximate idea of the percentage of 
deformities in this community at least It is possible, how 
ever, for the facial bones to hecoine excessively developed or 
arrested and the jaws normal, and it is also possible for the 
jaws to be deformed and the face apparently normal. A.S 
compared with degenerate classes found in our asylums the 
percentage is from 25 to '■'>'■'> percent less. 



CHAPTER XXIX. 

NEUROSES OF DEVELOPMENT OF THE MAXIL- 
LARY BONES. 

Excessive growth of bone-tissue is frequently seen in con- 
nection with the superior and inferior maxilla?. It may be a 
natural growth or the result of disease. If the jaw is natur- 
ally large, it will develop gradually, and will not attain its 
full size before the age of from twenty-six to thirty-six years. 
The size of the jaw corresponds quite closely to the size of 
the head, other things being equal, the large head containing 
the large jaw. We occasionally find, however, a very small 
jaw in a very large head, and vice versa. The upper jaw is 
more subject to morbid influences than the lower jaw, 
because of its development in connection with the bones of 
the head. The lower jaw rarely exceeds the average size. It 
is possible, however, by constant use, to increase the size of 
the jaws, as is shown in acrobats and those who use their jaws 
in performing various feats, like " the man with the iron 
jaw." The jaws of tobacco-chewers. singers, public speak- 
ers, and the skulls of the early races who lived upon corn, 
shells, roots, etc., show that the jaws may be increased, or at 
least favored in their development, in size, by use. 

Enlargement of the jaw-bones is an occasional cause of 
dental irregularities. It may occur in either jaw, but gener- 
ally in the upper, and is due to hypertrophy on the one hand, 
or hyperplasia upon the other; also to osteitis, periostitis, 
continued irritation drawing blood to the part, and, in some 
cases, to disease of the antrum and nasal fossa, producing 
the same effect. Disease of the antrum may cause either 
periosteal or osteal enlargements. Hereditary syphilis has 
an especial predilection for the cones, particularly at the 
junction of epiphysis and diaphysis. The growth of the 
teeth does not proportionately increase, and the consequent 
disproportion between the teeth and jaws necessarily pro- 
duces a deformity. The forms of irregularities of the teeth 

804 



I ill HEAD, FACE, JAWS AND TEETH 

that co-exist arith crowded arches are do! seen in enlai 
jaws. Rachitis in children, whether due to syphilis or not, 
causes h\ pertrophj and h.\ perplasia of the jap i. I be li\ per 
trophy and hyperplasia maj be localized in some portion at 
the jaw, causing it to be unevenly developed, ks illustrative 
of the interesting character of some of these conditions 
described, I take the liberty to present a fen cases which have 
come under m\ notice. 

( k8i I Arrest of development. Girl, aged ten years. 
Fa! h»r and mother have well-developed jaws. Consumption on 
father's side; cancer on mother'- side. Child scrofulous, 
with small bones, especially the maxillarj bones, which are 
unusually small. The teeth of both jaws (permanent first 
molars and incisors, temporary cuspids and molars) are in a 
very crowded condition. The teeth are normal in size. With 
such unusually small jaws, and the teeth at this aire being verv 
crowded. 1 shall watch this case with great interest. f I 
.shall expect to find marked V or saddle-shaped arches. I 
have observed similar results in like cases. 

Case II. Arrest of development Girl, aged sixteen 
years. When quite young had a severe attack of scarlet 
fever, and the arrest of the development of the bony frame- 
work resulted. The jaws are unusually small, and the teeth 

are crowded to Such an extent that the CUSpids remain out 

Bide the arch. 

Cask III. —Enlargement of the superior maxilla. George 
W., aged fourteen years. This boy was sent to me for an 
opinion in regard to his teeth. LTpon examination I found 

the teeth of the normal size. Spaces existed between .-til the 
teeth as far hack as the first permanent molars. The 
bicuspids were not fully developed, hin were through the 
gum sufficiently to notice their position in connection with 
the other teeth. The spaces were not uniform, those between 
the incisors being the largest. The widest Bpace was between 
the central incisors; the incisors of the lower jaw comino in 



•This is noticed in the second edition, 1£ 

* This girl is now under treatment. The jaw- are arrested in their devel- 
opment, ami a marked V-shaped arch was produced. 



30G ETIOLOGY OF OSSEOUS DEFORMITIES OF 

contact with the mucous membrane of the mouth posterior to 
the superior incisors. 

Case IV. — Hypertrophy of the jaw. J. B., aged nineteen 
years. This patient came under my treatment in June, 1887. 
When fourteen years of age he received a blow upon the side 
of the jaw. He is of a scrofulous nature. The blow pro- 
duced a low form of inflammation, and hypertrophy of the 
bone supervened. The teeth of that side of the jaw were 
carried laterally, and spaces existed between the bicuspids 
and molars. 

Case V. — Antrum disease. Boy, aged seven years. Ger- 
man descent; born in this country; scrofulous. Quite a 
deformity was noticed upon the left side of the face, pro- 
duced by the bulging of the antral wall. Hypertrophy of 
the alveolar process also existed. The temporary teeth on 
the left side of the upper jaw extended beyond those of the 
lower jaw. Upon opening into the antrum a thick, ropy 
fluid exuded. After three months' treatment no improve- 
ment has been noticed. 

DEVELOPMENT OF THE INFERIOR MAXILLA BY EXERCISE. 

The superior maxilla is influenced to a greater degree by 
the various causes of jaw-deformities than the inferior max- 
illa. The bones of the upper jaw are in direct contact with 
the other bones of the body, while the lower jaw, unlike all 
the other bones, develops independently, and is only 
attached at its remote extremities by articulation. The 
growth of the body of the bone is free to develop or to remain 
in a dwarfed condition, depending wholly upon its nerve and 
blood-supply for its nourishment. The superior maxilla, as has 
been stated, shows indications of gradually diminishing in 
size. The inferior maxilla, although under the same influ- 
ences, has a powerful factor to aid its preservation, viz., 
motion and exercise. On this account the question presents 
itself, as to what extent certain properties of the jaws, influ- 
enced by habit (use), may be transmitted. The tissues of the 
body, especially those of the osseous and muscular systems, 
possess a certain degree of plasticity, by which they are 



I III III \h. I \< I . I \\\ - \\h II II II 

enabled to ohange their weight or shape, This quality 
depends upon the use of muscles and bonei kmong rerte 
bratee u< find b olose relation between the muscles and the 
bones upon which they are inserted. The union i- made up 
of tendons, which are prolongations of the muscles to the 
periosteum, and the periosteum] is attached to the bones. 
Powerful muscles and large bones are always associated, 
exercise developing them both simultaneously. As outward 
changes occur in the life of human beings or animal-, adjust- 
ment to environment tends t<> alter the physical character 
istics. These changes often occur through Buch gradual mod 
ifications that from one generation to another but little 
marked difference is noticed, but the structure, in the course 
<>i a number of generations, will so change that a new species 

will be developed. Anv animal domesticated from a wild 
life shows this change, and among human beings the negro 
imported from Africa will, after several generations have a 
less prominent jaw hone, and the frontal hone will become 
more prominent The changes, although existing in the 

white race-, after intermarriage with other nation-, are not 
so pronounced and rapid as in the negro cross-breed, but are 
gradually occurring. No part of the body demonstrates 
these changes SO forcibly as the -ulterior or inferior maxilla. 
The extremities must be measured and weighed to compare 

the tWO halves of the body. 

The accustomed eye can at a glance compare the jaw- and 
teeth and observe the slightest deviation. Whatever views 

are held regarding the origin of man, it cannot be denied 
that the human jaws of the earlier race- resembled those of 
the anthropoid ape. whose upper and lower maxilla* protruded 
and appear to be uniform. Observation will show that the 
changes in the shape of head and jaws are not confined t<> one 
race nor to past generation-, but are continually progressing. 
These change- are not uniform in the two jaws. The supe- 
rior maxilla is a fixed bone, and the inaction, from lack i^i 



* In -nine instances the laws of hereditary and sexual selection 
sarily co-operate with environment in producing this cha- 



308 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

exercise, gradually affects and diminishes the volume of bone- 
tissue from one generation to another. 

The inferior jaw, on the other hand, is constantly in 
motion, which causes a flow of blood to the part, and the 
activity of nutrition in the muscles and bone increases their 
size and strength. This increase of the bone by exercise of 
the part has been alluded to by C. Harting in reports of 
examinations made. He says that "the bones of the right 
upper limb are generally larger than those of the left." This 
increase in size was not confined to one bone, but to all the 
bones of the right limb. The weight of the right arm with- 
out the hand is to the weight of the left arm without the hand 
as 106.2: 100, a difference of about six per cent, which would 
indicate not only an increase in the volume of muscle, but in 
the weight of the bone. Exercise of the inferior maxilla, which 
has always existed, has developed the jaw, while the superior 
maxilla has dwarfed from non-exercise. The contour and 
expression of the face depend, to a great extent, upon the 
shape of the inferior maxilla. Frequently this bone will 
exhibit peculiar family characteristics in early life. Oftener, 
family resemblances are not established until the individual 
has attained his full growth, from the thirtieth to the fortieth 
year. Hereditary peculiarities may exist at birth, like the 
transmission of features, or color of eyes or hair, but family 
likenesses may not appear until middle life, like the contour 
of the face, shape of the nose, or shape or size of the inferior 
maxilla. Such being the case, it may be assumed that motion 
and exercise are the prime factors in assisting the develop- 
ment of the inferior maxilla. 

ASYMMETRY OF THE LATERAL HALVES OF THE MAXILLARY 

BONES. 

Asymmetry of the lateral halves of the maxillary bones 
exists in the present era of the human race, and, like other 
irregularities and imperfections in the structure of the body, 
it prevails to a greater extent among neurotics and degener- 
ates, and among the offspring of mixed races, than in clannish 
tribes or nations. Each lateral half of the body develops 



I ill HEAD, FACE, JAWS AMD TEETH 

independently of the other. The jaws, like other memb 
are influenced bj the independent growth of the two halves, 
bo that each has its own peculiarities. Asymmetry, tl 
fore, is « an-t*. I from an inharmonious lateral development of 
the parts. The superior and inferior maxillary bones, gitw 
ins independently of each other, may be subjected to peculiar 
conditions of environment, so that the result of their 
development may be asymmetry of the jaws. Extreme 
asymmetry of the lateral halves of the human body is fre 
quently observed, and. as some of the recorded cases are of 
Bpecial interest, 1 will mention a few of them. 

These cases arc bo marked thai thc\ are noticeable by the 
most casual observer. In measuring the lateral halve- of the 
bodv l)y the system of measurement of criminals and convicts, 
introduced some years air" by M. Bertillon, we shall find 
that the halves do not harmonize in a Bingle instance. These 
differences are not altogether inherited or natural, but have 
been acquired, to a certain extent, by exercise of the part. 
Marked illustrations of development by exercise are seen in 
the blacksmith, whose right arm is larger and will weigh 
heavier than the left. The peddler who carries a pack has 
the Bide most in usedeveloped more than the other. 

If exact measurements of the maxillary hone- could be 
made, a lack of harmony in the lateral halves would be 
observed in weight, shape and Bize. The difference is gen 
erally not sufficient to affect the contour ^\ the face, bul 
causes faulty articulation to the teeth upon that side of the 
t':t«e. This is generally due to the number of teeth that 
remain in the jaw late in lite. Thus a molar or bicuspid 
may never have developed upon one side, while the full num- 
ber are in position upon the other Bide, or they may have 
been extracted upon one Bide, while the full number remain 
upon the other. Again, owing to an irregularity of the teeth 
in the anterior part of the mouth the posterior teeth, although 
all are present, may have moved forward. In any of the-, con 
ditions the alveolar process and jaw would become Bhorter 
upon one side than upon the other, owing to absorption of the 
alveolar process. The deformities of either lateral Bide ^i the 



310 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



superior maxilla are not necessarily like those of the inferior. 
Excessive growth or arrested development appear upon both 
sides of the jaws, sometimes on the right and again upon the 
left. Examinations of these deformities can be made only 
when the second teeth have been extracted and the alveolar 
process has been absorbed. 

Fig. 92 shows the superior maxilla after absorption has 
taken place. If a line be drawn through the jaw at the median 
line, it will be seen that the left half is fully developed, while 
the right half is contracted at the bicuspid region. The fol- 
lowing statistics show the deformities in the contour of jaws 
modeled by Dr. L. P. Haskell, of Chicago, who has a large 




Fig. 92. 

collection of models, and who kindly assisted me in their 
examination: 

UPPER JAW. 

Total number examined, - - 298 

Total number normal, - - - 137 

Total number abnormal, right side, - 73 

Total number abnormal, left side, - - ss 

Fig. 93 illustrates the inferior maxilla after the teeth have 

been extracted and absorption of the alveolar process has 

taken place. By drawing a line through the center of the 

lower jaw at the median line, a wider space may be seen to 

exist between the line and the left side than on the other side. 



Till IIKAD, I \< I . I \\\ - \\ |. I I I I II 



31 I 



I < »\\ I i; i \w . 

Total Dumber examined, - • l ."• i 

Total Dumber normal, - - 6 1 

Total number abnormal, right side, 12 

Total number abnormal, left Bide, 
In the -tu.lv (>{ irregularities of the teeth during the past 
eight or ten years, I have observed that, although no two 
oases of irregularities of the teeth are exactly alike, there is a 
genera] similarity of shape and outline of alveolar pro 
and jaw, owing to similar environments during eruption of 
the teeth. Upon the hypothesis that the two halves of the 




Pig. 93. 

BUperior maxilla are developed in proportion to the exec-- of 
food masticated on one side or the other, depending upon 
right and left-handedness of the individual, we suppose that 
the case illustrated is that of a left-handed person, as the left 
Bide of the jaw is larger. But it appears that this side is nor- 
mal in size and the right is detieent in development. By 
examining carefully the contour of patients' teeth, we shall 
observe that but few arches are uniform. While one side 
may be normal the other will be depressed. Fig. '.♦-I shows 
such a deformity. This cut is taken from a model of an 
extreme case of irregularly-shaped jaw. It represents a per- 



312 ETIOLOGY OF 08SEOU6 DEFORMITIES OF 

fed semi-V-shaped arch. (I find in my collection of models 
thirty-eight of this variety of deformity, twenty-four of 
which are on the right side and fourteen on the left.) Most 
of these irregularities are not quite as depressed at the cuspid 
region as the cut indicates. No two are exactly alike as 
regards the position of the teeth, and yet the similarity is so 
complete that a non-professional man would immediately take 
notice of it. The asymmetry of the jaw illustrated in Fig. 92 
is probably caused by the peculiar arrangement of the per- 
manent teeth in the arch, since the deformity is not apparent 
during the first set of teeth, the alveolar process and maxillary 
bones being molded into this peculiar shape thereby. Since 
but few people are left-handed, this percentage is very large, 
showing twenty -four out of thirty-eight cases with deficiencies 
on the right side, when we might look for normal or exces- 




sive development on that side. The, cause of this irregularity 
I believe to be local in its origin, viz.. too early extraction of 
the temporary teeth upon the affected side, thus showing that 
one side is as liable to be affected as the other. The mechan- 
ism of this irregularity will be found under the head of local 
causes. 

The asymmetry upon the lower jaw may be traced to two 
causes: 

First. The full number of teeth retained upon the long 
side. If the third molars should develop on one side only, 
the jaws on that side would expand by the crowded condition 
of the teeth and extend farther from the median line than 
otherwise. The loss of the third molars by extraction or 
non-development would prevent the other side from increas- 
ing to the natural size. 



till III \l». I \l I . .1 \\\ 



\\ 



1 1 I 1 1 



i:; 



S The relation of the upper teeth to the lower teeth. 

The articulation of the inferior maxilla with the cranium is 
bo remote, and the contour of the two bones so unlike, thai 
uniformity of bone-structure cannot be looked for. When 
we consider the complexity of the development of bone-tia 
sues, first oi the maxillary bone, then of the alveola] pro 
and lastly of the two sets of teeth, it is a wonder thai bar 

ii)<»n\ ever piv\ ails. 

kSI mmi I \:\ I 'l i in. m will LB1 B4 >\ i 9. 

// ikeWt Deformity.* When we examine models of the 
auperior maxilla after absorption of the alveolar process has 




taken place, we observe that In Ihe cuspid and bicuspid 
region, high above the alveolar border, a marked depression 
exists on either side. Fig. 95 -how- a base-plate which has 
been formed over such a model. The plate is more d< 

at the left than at the right side. This peculiar deformity is 
familiar to the operator who arran_ i and waxes up 

plates for the purpose of restoring the contour of tin- face. 
Upon closer inspection of the model it will he Been that there 
is an asymmetry of the lateral halve- of the maxillary hone-. 
With Dr. Baskell's assistance, I have examined --". ,s models, 



■ l have named this deformity •• Haskell's Deformity," for the reason tti.it 
Dr. Haskell called the attention of the profession to this peculiar condit 
the maxillary \« illy and through the journals, and say- he 

has found but one dentist who had observed it. 



314: ETIOLOGY OF OSSEOUS DEFORMITIES OF 

finding 268 out of the number with marked depression on the 
left side, and twenty-four with the depression on the right 
side, and only six cases showed both sides to be alike. It is 
remarkable that so large a proportion of the cases of this 
deformity should be found existing on the left side. 

Dr. Haskell says: "For many years I have observed a 
marked difference between the right and left sides of models 
of both the upper and lower jaws, but more especially notice- 
able in the upper jaw. It is not so apparent upon a casual 
glance at the model, for it is not so much in the alveolar pro- 
cess as in the maxillary bones. But a plate swaged upon a 
model from an impression taken high over the region of the 
cuspids (as ought always to be done) shows at once the depres- 
sion of the left side, which occurs, to a greater or less extent, 
in ninety-five per cent of cases. The difference becomes 
apparent in arranging artificial teeth. Every dentist of expe- 
rience must have observed that greater length of teeth and 
gums is required upon the left side than upon the right. 
How often it is seen that the left side of the lip rises higher, 
in talking and laughing, than the right side. The difference 
in the two sides of the lower jaw does not occur as often, but 
is apparent in the divergence of the left side from a line 
drawn through the centre of the model, so that the posterior 
teeth on that side must be set farther in upon the plate." 

Dr. Haskell has, during the past twelve years, frequently 
called my attention to this peculiar deformity of the jaw. 
My own observation of models and patients has also indicated 
the probability that the majority of deformities of this nature 
exist on the left side. The following theory for this deform- 
ity suggests itself as worthy of our consideration: Man, like 
some other members of the animal kingdom, moves the lower 
jaw from right to left in mastication. (As people are some- 
times left-handed, so it is possible to find cases where the 
jaws moved from left to right. I have, however, found only 
three such cases.) The constant friction of the lower teeth 
against the upper, carries the superior arch with the alveolar 
process toward the left. By pressing the index finger over 
the cuspid and bicuspid roots, above the alveolar process, we 



l mi ill IAD, i \« i . FAWi UfD i ii i ii 

Bhall tin- 1 that the majority of mouthfl oontaiin teeth with their 
roots standing out more prominently upon tin- 1 i!_ r ht ride than 
apon the left ride. The right superior dental arch, like the 
arch oi a bridge, resists Buch Inward force because of the 
lateral oontaot of Its teeth. <hi the oontrary, the lefl supe 
rior dental arch may thus be carried slightly outward. The 
limited lateral motion during occlusion prevents the teeth and 
alveolar process from being carried farther. The cuspid 
tooth may be prevented from being carried in as far as it 

otherwise would DC Owing to the lateral motion of the lower 

jaw to the left. The alveolar process is thus carried beyond 
the border of the maxillary hone-. After the teeth have been 

removed, absorption of the alveolar prOCCSS OCCUTS, leaving 

only the alveolar ridge. The ridge then overhangs the max- 
illary hone, thus producing a depression upon the left ride. 

This is the reason that, in arranging artificial dentures in 
many eases, the teeth are carried over the alveolar border 
farther than upon the right side to obtain proper articulation 
with the natural teeth upon the lower jaw. 

On examining the model upon which the base-plate was 
formed, it will he seen that both the right and left alveolar 
border- are symmetrical. The alveolar border in most cases 
indicates the contour of the teeth when in position. 

ASYMMETRY IN THE KAMI. 

A case recently seen with Dr. G. Frank Lydston, of this city, 

is a marked illustration of congenital maxillary asymmetry. 
The man is thirty years of age. The inferior maxillary is 
small and the chin pointed and narrow. There i> a differ- 
ence of one-half an inch in the length of the rami, the left 
ramus being the shortest. The difference is sufficient, when 
the face is smoothly shaven, to produce a noticeable deform 
ity. The teeth are irregular in both jaws, the irregularity, 
however, being most marked in the superior jaw. The cra- 
nium partakes of the asymmetry, and the frontal suture i- 
plainly marked. Numerous irregularities of the surface i)i 
the skull are observable. The larynx is displaced at least 
one-half an inch from the median line toward the left side. 



316 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

There is no history of injury, and a point of interest in this 
case is the fact that the asymmetrical and small jaw is a fam- 
ily characteristic, and has been noticed for several gener- 
ations. The jaw, in this case, resembles the father's, while 
the arrangement of the teeth is similar to that of the mother. 
The upper portion of the body appears to have been developed 
in two lateral halves, and when brought together the left side 
of the body was higher than the right side. The cranium 
and maxillary bones show this deformity quite conspicuously. 
The teeth, which are comparatively sound, are all present. 
The left superior maxilla is considerably higher than the 
right. Occlusion is perfect, thus compensating for the short 
left ramus. 

Another very interesting case, and similar, is that of 
a young lady, twenty years of age. Has arrest of develop- 
ment of the upper jaw; the body of the lower jaw is exces- 
sively developed. Length of right ramus, 2.25 inches; left, 
1.50 inches. The result of which is the lower jaw thrown 
to the left the width of the right central incisor tooth. I am 
informed that the father and uncle possess a similar 
deformity. 

ASYMMETRY IX THE BODY AND IMPROPER OCCLUSION. 

The daughter of an old patient came to me for treatment 
September 11. 1888. She was about seventeen years old. and 
had quite a prominence upon the right side of the lower jaw, 
and another, although not so marked, upon the left upper 
jaw. The left corner of the mouth was nearly one quarter of 
an inch higher than the right. The face was full and had a 
peculiar expression, owing to the mouth and jaw being at an 
angle when closed. Upon examination, 1 found the left 
superior maxilla one-quarter of an inch higher than the right 
side. The alveolar process and teeth shared the same irregu- 
larity, thus placing the line of the teeth on the same plane as 
the lips. The body of the inferior maxilla, from the sym- 
physis to the angle, seemed to be longer upon the left side 
than upon the right. When the jaw closed, the median line 
of the lower jaw was half an inch to the right of the upper. 



1 111 ii i \i». i \< i . i \\\ - wi> 1 1 i/i ii '.IT 

The Lingual cusps of the bicuspids and molars on the right 
side of the lower jam occluded with the buccal cusps of the 
bicuspids and molars of the upper, and upon the 

left Bide. 

Asymmetry maj be due to excessive development oi th<- 
bodj of the jaw on one aide, and arrest of development "ii 
the other. 

Hie two oases just described are interesting from the fact 
that while the causes and the external appearances of th< 
are entirely different, the alveolar processes and theocclud 
ing surfaces of the teeth are on the same angle, the Inclination 
being In the same direction. This deformity Is frequently 
found in the mouths of patients over forty years of age, where 
all the teeth have been removed upon the Bide of one jaw and 
upon the opposite side of the other, the alveolar proa 
containing the teeth elongating upon the Bide where tin 
no antagonism, and throwing the occluding line of the teeth 
out oi position at an angle Bimilar to that above described. 

By examining the mouths of 1,977 idiot- there were found 
to be 159 with protrusion of the superior maxilla, and 92 with 
protrusion of the inferior maxilla. These deformities do 
not exist to such an extent among healthy individual-. 
This inharmonious development ^t' the maxillary bones may 
extend from the articulation to the incisor teeth. Such deform- 
ities are rarely found in connection with the first Bet of 
teeth. When the alveolar process protrudes during the period 
of the temporary teeth, it is usually caused by thumb-sucking 
or an arrest ^i development ^i the inferior maxilla. Protrusion 
of the inferior maxilla Is the result of the abnormal development 
of the rami or body of the jaw. or an arrest of development of 
the superior maxilla. A- these abnormal conditions usually 
correct themselves when the temporary teeth are shed, they 
consequently receive little attention. But when these deform 

[ties arise during second dentition the jaw- arc determined 

toward false positions, thus endangering the beauty i^t' the 
fact-. We occasionally see excessive growth or physiological 

hypertrophy of the superior maxilla when the inferior max- 
illa i- unusually developed. When the teeth are normal in 



318 



ETHOLOGY OF OSSEOUS DEFORMITIES OF 



size they appear small in proportion to the abnormally large 
jaw. They are carried forward with the alveolar process to 
such a degree that the teeth and lips may protrude. In such 
cases it appears as if the body, or rami, of the inferior max- 
illa were much shorter than is natural, but by close inspection 
we shall see that the inferior maxilla is normal, and quite a 
space exists between the superior and inferior central incisors. 
A slight protrusion of the superior teeth is a common defect; 
it is usually accompanied by a depression of the face at the root 
and alae of the nose, and a protrusion of the anterior alveolar 




Fig. 96. 



process and upper lip. If the maxillary bones, as well as the 
alveolar process, are enlarged, the teeth will stand perpendic- 
ularly with the alveolar process. If the superior maxillary 
bones are small, the teeth will protrude from the perpendic- 
ular to an angle of 45°. Such a case is illustrated by Fig. 64, 
page 131, Kingsley's "Oral Deformities." This is a deformity 
frequently met with in practice. A common cause of pro- 
trusion of the superior maxilla is illustrated in Fig. 96.* The 
teeth in the upper jaw are fully erupted, but are directed 
downward and forward; the teeth in the lower jaw are in 
their proper position. It will be observed that the rami 

* These cuts represent cases in my practice. 



I II I III \l'. I \i I . .1 \W B \M' I I I I II 

of the jaw are inharmoniouslj developed) the rami being 
bo short when tin' jawa olose that the occlusion throwa the 
superior teeth and alveolar process forward. In thii 
the alveolar process is quite thin, ttecanse the arch ifl high 
and the teeth, having long slender roots, are easily carried 
forward. The Inferior maxilla ifl large, the structure donse 
and hard, and the teeth firmly fixed in position in the jaw. 
When occlusion takes place, the weaker structure (the superior 
maxilla is carried forward by the Btronger i the lower maxilla >, 
thus forcing the alveolar process forward, producing harmony 
throughout the articulation. The shortness of the rami of 
the inferior maxilla, causing improper closing of the jaw 




a feature strongly impressed upon the dentist who undertakes 
to insert artificial dentures. The tendency of the lower jaw- 
to force an upper denture out of the mouth, by striking the 
teeth at an angle instead of perpendicularly, is a marked illus 
tration of the inharmonious development of the jaws. The 
Bame difficulty is frequently experienced with the partial 
lower plate when it presses against the anterior teeth and 
alveolus, forcing them both forward by improper articulation. 
The occasional grinding of the Burfaces oi the artificial 
molars to produce proper articulation affords another illus- 
tration of the effects of this inharmonious development. 



320 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

IMPERFECT OCCLUSION. 

Fig. 97 illustrates a deformity produced by the before- 
mentioned cause; yet the result is very different. The case 
is that of a boy fourteen years old. Before the eruption of the 
second molars, the articulation was perfect; but as soon as the 
second molars occluded the jaws were forced open. The rami 
are so short that when the second molars and the alveolar 
processes of the superior and inferior maxilla come together, 
a space exists between the central incisors. 

Unlike the former case, the superior alveolar process is 
remarkably well developed, and the teeth are firmly fixed in 
the jaw. The vault of the mouth is quite low. The position 
of the teeth, in the alveolar process, is such that when the 
lower teeth occlude they strike directly on a line with the 
long axes of the roots, thus preventing the forward move- 
ment of the teeth and alveolar process. The inferior maxilla 
is not well developed, nor has it the power to overcome the 
resistance, and force the superior alveolar process and teeth 
forward, as exemplified in Fig. 96. When the rami are short, 
so that they do not harmonize with the maxillary bones, the 
movement of the jaws may be likened to the arms of shears: 
the farther the points are from the centre, the greater the 
distance they have to travel. A slight movement at the 
centre will cause them to move a considerable distance. In 
a similar manner, a slight excessive protrusion of a molar 
will cause the anterior teeth to become separated. The 
shorter the rami, the less the harmony between the jaws and 
teeth; the farther back the protruding molar, and the more it 
projects, the greater the anterior separation of the jaws. 
The excessive eruption of the second and third molars is very 
often due to the persons sleeping with the mouth open, the 
pressure upon the posterior teeth being removed the teeth, 
and even the alveolar process, will elongate. Not infrequently 
the mal-occlusion of the teeth is due to the inability to close 
the jaws on account of the inharmonious development. 
Occasionally there are mouths in which the molars and 
bicuspids occlude, and there is just enough space between the 



1111 III \l>. 1 \< 1 . JAW.H \M« I I I 1 II 






oentrals to admit a thin Bpatula. January, i vv 7. a pal 
was brought to me for advices hose jaws, when closed, iho 
a Bpaoe of half an inch between the incisors, Such cases are 
due to arrest of development of the anterior alveolar pro 

the superior dental arch being too small for the Inferior. 
The pressure of the jaws upon the molar teeth is, In some 
instances, so great that normal eruption is impossible. In 
Bach oases the molars will protrude through the gum, an. I the 
Buperior and inferior processes will occlude when the jaws 

meet. 




Fig. 

PEOTKU8ION OF THE QTFERIOB MAXILLA. 

Protrusion of the inferior maxilla produces one of the 
most repulsive deformities of the face, and Bhould be cor 
rected as early in life as possible. When it is caused by or 
associated with arrested development of the superior maxilla, 
it is extremely difficult to re-tore the feature- to a natural 
expression. A case of considerable interest, illustrated by 
Fig. 98, came to my notice in l sv 7. A commercial traveler 
from New York called at my office for the purpose of having 
a gold crown re-set. I noticed a marked deformity In tin 4 
jaws, consisting of a depression at the a he of the nose and an 
unusual protrusion of the inferior maxilla. Upon examina- 



3-2-2 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

tion I found that the second molar on the upper jaw and the 
third molar on the lower jaw were the only teeth that 
occluded. This was caused by arrest of development of the 
bones of the face and an excessive length of the rami of the 
lower jaw. The body was normally developed, but was car- 
ried forward by a lengthening of the rami. To add to this 
deformity, there was a marked arrest of development of the 
bones of the face. There are cases where the lower jaw pro- 
jects beyond the upper; but by closely examining the deform- 
ity, we find that another cause exists for this appearance.' 

A girl, fifteen years of age, was sent to me for treatment 
by a dentist from a neighboring state. He desired me to 
"force tlie inferior maxilla back into place." I found the 
rami and body of the jaw apparently normal. The external 
appearance of the chin and cheeks was in keeping with the 
outline of the face. I observed that the upper lip was much 
depressed, and that deep lines extended from the alae of the 
nose to the corner of the mouth. The cheek bones were also 
undeveloped. Upon opening the mouth I found arrest of 
development of the superior maxilla. The superior incisors 
closed inside of the inferior incisors; the first and second 
bicuspids, first and second molars, were in position, but had 
crowded forward close to the lateral incisors. The cuspids 
were quite outside of the arch. The superior dental arch had 
to be forced out, instead of carrying the inferior maxilla in, 
which would tend to further complicate the case. 

Another instance is that of a young man with what seemed 
at first, and what an old practitioner had regarded, as a "prog- 
nathous lower maxilla." This I found upon inspection to be 
caused by arrested development of the upper maxilla. This 
dentist had spent five years in trying to reduce the deformity. 
It was fortunate, however, that he was unsuccessful, for had he 
succeeded the deformity would have been made greater than 
it was. Instead of moving the lower teeth back, the upper 
teeth should have been moved forward. In six months' 
treatment by this plan the teeth were corrected and the face 
was greatly improved. 

In the majority of cases which appear to result from a 



I in. ill \ I », I m I . JAWS LND i i i I ii 

protrusion of the lower jaw, wre shall tin* I that the lower mai 
ilia does not project abnormally, but the superior maxilla, 
being arrested in Its development, gives the protruding 
appearance to the lower jaw. Before undertaking t<> 001 
Buch a deform it} the general contour of the face should be 
carefully Btudied. M\ experience has been that many mis- 
takes have been made by operators who did not understand 
the true condition of the patient 

A peculiar but common deformity of the inferior maxilla 
i- illustrated in Fig. 99. The body of the jaw i- very short 
A line dropped perpendicularly, and touching the chin at the 
median line, would pa-- through tin' bicuspid region of the 




Pig. ;»!». 

superior maxilla. A front view of such a deformity gives an 
appearance a- though the lower jaw were absent, ami a side 
view throw- the nose out prominently, while the chin and 
forehead retreat. The rami of the jaw are larger than the 
body. The articulation is good, the defect being that in the 
incisor region the teeth strike quite a distance posterior to 
the superior incisors. Arrest of development of the lower 
jaw frequently results when the superior incisors are crowded 
inward irregularly, or when there i- arresl of development 
of the superior maxilla the lower incisors coming in contact 
with them, thus preventing the forward development of the 
body of the jaw. The anterior portion of the lower jaw 



324 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



remains stationary, while the development is in the posterior 
direction. 

Fig. 100 represents jaws such as are frequently seen. 
The long body and protruding chin, narrow and contracted 
alveolar process on the lower jaw, a small superior maxilla and 
thin protruding alveolar process are in keeping with the thin 
faces and sharp features of the class. The body of the inferior 
maxilla is small, thin and very delicate; the rami unusually 
short — just the opposite to the one last described. A line 
drawn parallel with the occluding surfaces of the teeth would 




Fig. 100. 

meet the angle of the jaw, which, in a normal jaw, would 
extend from one to one and a half inches below the line. 
Naturally slender, delicate muscles and tendons are associ- 
ated with such bones. In these cases dislocation of the infe- 
rior maxilla is liable to occur while yawning or during dental 
operations, so great is the leverage. In this instance the 
length of the jaw compensated for the width, so that in this 
particular case the teeth are not irregular; although irregu- 
larity frequently accompanies this peculiar . formation of the 
jaw. This is particularly the case with the saddle or V-shaped 



I ill ill ID, r H »■:. JAWS \M' i i i I H 






arches on the apper jaw, and the saddle shaped and forward 
Inclination of the molars, bicuspids and cuspid teeth on the 
lower jaw. The roof of the mouth is also 1 ery high and th<- 

alveolar process very thin, uivimr the roots of the teeth but 




Fig. 101. 

Blight support. The same principle of organization and 
structure is operative in the alveolar process and teeth of the 
lower jaw. 

Fig. L01 represent- the jaw- of a patient. twenty-six years 




Fig. L02. 

of age, who came to me for treatment. Upon examination I 
found a small normal inferior maxilla, well protruded, and 
in harmony with the other feature- of the face. The supe- 
rior maxilla and alveolar process were excessively developed, 



326 ETIOLOGY OF OSSEOUS DEFORMITIES 

the first molar and anterior teeth describing a much larger 
circle than the lower. The second molars were the only 
teeth that articulated properly. The anterior alveolar pro- 
cess had taken on a prolific deposition of bone-cells until the 
teeth impinged upon the gum of the lower jaw, producing 
absorption and expansion. The upper lip was covered with 
a mustache which completely hid the deformity. Under such 
conditions a prominence is observed at the alas of the nose — 
the upper lip being drawn over the alveolar process. 

Fig. 102 represents a case rarely met with. The body of 
the inferior maxilla is excessively developed, the extent of 
the irregularity depending on the degree of development. 
When only a slight protrusion exists the incisors strike 
beyond the superior incisors. In extreme cases only the 
molars articulate. When only the anterior teeth articulate 
the alveolar process develops so that the teeth extend to the 
superior alveolar process. The features may be quite regu- 
lar otherwise. This deformity is common among negroes, 
and is called prognathism. Asymmetry of the jaws fre- 
quently continues to develop until the osseous system has 
obtained its growth. 



CHAPTER XXX. 

NEUROSES OF DEVELOPMENT OF THE V.\i LT. 

It is a singular fact that depressed palates and irregulari- 
ties of the teeth were first observed and described by medi- 
cal men, Langdon Down called the attention of the medical 
profession to the feci that high vaults, as well as irregular 
shaped jaws, were verj common among idiots and congenital 
imbecility. In :i paper, read before the Odontological 
Society of Great Britain, he Bays, among other things, speak- 
ing of idiots in the Earlswood asylum: "Of the most signifi- 
cant value, however, is the condition of the palate. I have 
made a very large number of careful measurements of the 
mouth- of the congenitally feeble-minded, and of intelligent 
persons of the same air*', with the result of Indicating with 
some few exceptions a markedly diminished width between 
the posterior bicuspids of the two sides. One result, or 
rather, one accompaniment of this narrowing, is the inordi- 
nate vaulting of the palate. The palate assumes a roof-like 
form. The vaulting is not simply apparent from the approxi- 
mation of the two sides; it is absolute— the line of juncture 
between the palatal bone occupying a higher plane. Often 
there is an antero-posterior sulcus corresponding to the line 
of approximation of the two bones. An appeal to the condi- 
tion of the mouth is an important aid in determining whether 
the lesion, on which the mental weakness depends, is of intra- 
uterine or post-uterine origin. In the event of the mouth 
being abnormal, it indicates a congenita] origin; while if the 
mouth i- well formed, and the teeth are in a healthy condi- 
tion, it would lead to the opinion that the calamity had 
occurred subsequently to embryonic life." Indeed. In- went 
so far as to state that these condition-, when observed in 
young children, were pathognomonic of idiocy. Upon fur- 
ther observation, however, it was found that many idiots and 
feeble-minded individual- possessed low. narrow vault-. It 
was also observed that many sane persons possessed high 
vaults, and V, and saddle-shaped arches. 



328 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

Dr. Clay Shaw * made extensive observations and accurate 
measurements of the mouths of idiots, and decided that 
" there is no necessary connection between a high palate and 
the degree of mental capacity of the individual." 

Dr. Clay Shaw believed that a high palate is invariably 
associated with narrow, pterygoid width, and a narrow 
skull, but this theory is of little value. By a close examina- 
tion of the vaults of the dolichocephalic heads, it will be seen 
that such is not the case, but that they are also to be seen 
among the brachycephalic and mesocephalic heads. 

Cuylitz,f a Belgian authority, accepting the views of 
Langdon Down, and others, as to the connection of a high- 
vaulted palate with mental deficiency, explains it as follows: 
" The brain tends to develop transversely, but it meets in 
some cases a resistance in the parietal region which crowds it 
back. This pressure, transmitted by the zygomatic, tem- 
poral and molar processes, pushes together the alveolar bor- 
ders of the superior maxilliaries like a workman's tongs, the 
approximation of the main branches of which — that is, of the 
parietals — brings the ends together, the hinge being repre- 
sented by the body of the sphenoid, and the occipital. This 
bringing together, therefore, of the alveolar borders, or the 
original palate, is only the expression of a cerebral collapse 
or abnormal effort, which in the psychic life reveals itself by 
degeneracy." 

The advantages of a law like the above are obvious, pro- 
vided always that it is a definitely established one. Even 
for a working hypothesis a certain amount of substantiating 
evidence is needed, and this cannot, it seems to me, be consid- 
ered as yet as anything more than an ingenious suggestion, 
which, however, is worthy of consideration. 

THUMB-SUCKrNG AND SIMILAR CAUSES PRODUCING HIGH 

VAULTS. 

As early as 1S34, J. Imrie stated, in Parents' Dental 
Guide, that "rabbit-mouth is due to keeping the thumb in the 

* Journal of Mental Science. July. 1^7«i. 

+ Quoted by Regis. Mental Medicine, 2d Edition. Paris, 1891. 



i in in \k i \« i . i IW8 AND TEETfl 

mouth tor hours after going to sleep. " Sinoe this time differ- 
ent authors have asserted that thumb, Soger, lip, tongue and 
sugar-teat sucking are the cause of the high or deformed 

vault. 

When we consider the size of the vault, eapecialrj its 
antero-posterior diameter, and compare it with above-named 
article-, it would seem abeurd to Buppoae, fora moment, thai 
there was an\ comparison in size between the two, <>r that s 
depression made by any one of these agencies could produce 
uniform width and height throughout the entire length of 

the vault. 

Children commence to Buck their iin_ >n after birth, 

and as absorption and deposition of hone cells take place 
faster at this time than at any other in the life of the individ- 
ual, one would naturally expect to find high, narrow vaults 
in connection with the first set of teeth or before the sixth 
year: hut Buch is not the ease. We frequently find children 
sucking their fingers who have very low vaults. 

Dr. Thomas Ballard read a paper on the "Constitutional 
[U-effects of Fruitless Sucking, and the Diagnostic Value of 
Deformed daw- in Relation Thereto," before the Odontologi- 
es] Society of Great Britain in 1864, in which he said: •• And 
as in idiots are seen the worst tonus of defective growth, so 
also do they exhibit the most aggravated forms of deformed 
jaws and teeth: the habit of Bucking being retained by them 
to an advanced age." 

I think I am correct in Btating that there are very few, if 
any, gentjemen connected with schools of idiocy who agree 
with Dr. Ballard in this statement. 

I am prepared to Btate that there are no more deformities 
of the palates among idiots than there are to be found an 
other defective classes. The worst deformed vault and dental 
arches I have ever observed were those of a murderer, sen- 
tenced for life in the Joliet Penitentiary. There are to he 
found among normal individual-, such as seek our service- in 
our offices, just as marked deformities as are >\ pved 

among the inmate- i)f our schools of idiocy, who are also 
known not to suck their fingers. The attendant-, who are 



330 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

constantly watching over them and caring for their welfare, 
would be very likely to notice if such vicious habits were 
being practiced, but such is not the case. 



In 1S91, Dr. T. S. Clouston published a paper in the 
Dental Record upon "The Hard Palate in its Relation to 
Brain Development," in which he divided the vault into three 
groups. The first he calls "Typical," or " Normal'' (Fig. 
103, No. 1). It corresponds to Ivy's section of the "horse- 
shoe arch;" the low, but regular wide dome, he says, is char- 
acteristic of the sanguine temperament. The second he calls 
the "Neurotic" (Fig. 103, No. 2), because he says "The 
deformity of the palate occurs during the brain-growth early 
in life, probably in utero. " He believes that it is a "bad 
initial neurotic heredity," just as we refer to a bad type of 
face or irregular teeth, or an asymmetrical head to such her- 
edity. The third class he calls tw Deformed" palate (Fig. 103, 
No. 3). It is of various shapes, all abnormal, but the most 
common form is very high, narrow, and at the top either V 
or saddle-shaped on account of the shoulder on each side of 
the teeth, he had described. 

While there is a certain amount of truth in the arguments 
used for the names, as we shall see later, he does not quite 
take in the situation. The terms "Normal," "Neurotic," 
and " Deformed" hardly define the conditions of the vaults. 
Thus, a normal jaw may contain a vault ranging all the way 
from .21, the lowest I have ever seen, to. 88, the highest, and 
all in a perfectly normal condition. If, then, a normal arch is 
like the horseshoe arch of Ivy's, what shall we call a normal 
arch that is .25 of an inch higher or lower? The neurotic 
arch, he says, "is more of a Gothic arch, with the alveoli 
tending to run more parallel and narrow down, the roof of 
which is formed by a larger part of a smaller circle." 

1 have observed neurotic arches very high and narrow, 
high and broad, low, and both narrow and broad, with marked 
neurotic jaws, face and head. 

The third class, which he terms "Deformed," compose 



1 III III \l». I \. I . IAWH Wl» I I I.I II 






Cloustons ClaMlfkqffori 




Fig. 108. 



332 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the V and saddle jaws. We shall see later that Clouston does 
not quite grasp the situation. Instead of reasoning himself, 
he allows himself to be carried away by the absurd theories 
of others. We shall see later that what he termed a deformed 
jaw is nothing more nor less than a neurotic condition, and 
that the deformed and neurotic are one and the same. 

Clouston uses the same argument that J. Langdon Down 
did in 1871, and Cole in 1881, that "excessive vaulting of 
the palate is due to arrest of development of the sphenoid 
bone," and "premature ossification of the suture at the base 
of the skull." He says, "in considering the palate and upper 
maxillary bone, one must take into account the following 
considerations, viz. : Its relations to the base of the skull in 
man. This relation is seen to be close and absolute as com- 
pared with the lower animals. 

" If a perpendicular line be drawn, marking the most anter- 
ior point of the brain, it is seen to fall, in man, through the 
center of the hard palate, while in the monkey it only just 
touches its posterior margin. 

" In man it thus has a direct relationship to the brain base, 
and its shape would be dominated by the width of this; while 
in the monkey it is nearly a part of the alimentary system, 
having little relationship to the base of the brain at all. No 
one can compare the two without seeing that its conformation 
in man will naturally follow any changes that take place dur- 
ing development in the skull-base. 

" If the skull in its growth, size, shape, dome and base, is 
absolutely dominated by the brain it contains, and on which it 
depends, then the brain-growth will, in this way, second- 
arily determine the shape of the upper maxillary bone and 
palate." 

I have quoted this part of Clouston's paper, because 
anthropologists invariably use this as one of the points in 
favor of the theory of the evolution of man, but I have never 
been able to see what relation the jaws and vault had to the 
base of the brain, or how any force directed by the sphenoid 
bone, through the vomer (if it were possible), could in any 
way affect the vault or shape of the jaw. 



I III lit \ l >, I \( I . JAWS \M » I l l l II 

It the intervening space between the base of the brain and 
tlir vault were solid, I oould easily Bee hon a change in the 
Bhape of one might exert an influence upon the other. The 
Bpace occupied by the nares being located between the two, 
with the two strong pillars of the superior maxillary bone 
upon either Bide as a resistance, to my mind precludes such a 
theory. The fact that the jaw has become less normal, or that 
the anterior lobes of the brain have developed :ui<l become 
more prominent, would lead me to believe in a general way 
thai the roof <>f the mouth should be leas vaulted, or, in other 
words, the base of the Bkull, which is situated above the vault. 
instead of posterior to it, would occupy much of the space 
necessary for the anterior and posterior nares, thus crowding 
down the vault. Thai any force, produced by the develop- 
ment of the hones at the base of the skull, or early or retarded 
ossification <>\' suture in that locality, could exert any influ- 
ence through the vomer, to my mind is not well taken. The 
fact that the vomer doe- not ossify until puberty, the thinness 

Of the bone, after ossification has taken place, and that it is 

most always crimped or deflected in one direction or another, 
would be conclusive proof that no effect could be produced 
upon a vault of hone supported by the anterior alveolar pro- 
cess, and with a rib or suture extending its entire length, 
which ossified years before any changes in the vault were 
noticed. We frequently observe the ridge and the two vault-, 
one on either Bide, extend anteriorly through the alveolar 
process nearly or quite to the incisor teeth. No one would 
think for a moment thai the vomer could exert any influence 
upon the palate, either up or down, through the maxillary 
bone and alveolar process. If the argument were true, the 
vomer, before it could draw up the vault, would necessarily 
have to be drawn taut, but we rarely observe such a condition, 
although the high vault- are numerous. 

Clou-ton says, further on in his paper: " Those palates, 
where the deformity consists in a ridge down the center. 
antero-posteriorly, seem to show that in them the deformity 
took place at a later period than in other deformed palates 
where the nasal septum was getting stronger and kept the 



334 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

center of the palate down, while on each side of it, the palate 
was drawn up, making two vaults, side by side, instead 
of one." 

This theory, however, is not correct. I have frequently 
observed this deformity in the center of the vault as early as 
the second year, or at the time of ossification. If his theory 
is correct, that the contraction at the base of the skull, pro- 
ducing pressure through the vomer, causes the high vault, 
and when ossification of the vomer stops this procedure what 
carries up the sides of the vault? Again, in such cases the 
vomer would be perfectly straight, which is not observed in 
such cases. 

Clouston reiterates a statement which has been made 
many times, that "the deformity of the palate (which, of 
course, must include the jaw) occurs during brain-growth, 
early in life, probably in utero." This theory can hardly be 
based upon a sound hypothesis, for the reason that the brain 
continues to grow until the seventh or eighth year. We shall 
see later that the vault does not change very much in height 
till after the sixth or eighth year; therefore a high vault can- 
not be said to develop early in life, much less in utero. 

THE VAULT IN ITS RELATION TO TEMPERAMENTS. 

Dr. Robert S. Ivy, in The American System of Dentistry, 
in the article " Dental and Facial Types," looks on them as 
being part of the morphology of the temperaments. He says: 
u The shape of the alveolar arch and the dome of roof of the 
mouth, also the articulation of the teeth, and the manner in 
which the gum is festooned over each tooth, are all indicative 
of the several temperaments, and present varieties worth 
attention. [Illustrated in Fig. 104.] 

"The arch of the bilious temperament, from cuspid to 
cuspid, is almost flat, the lines backward from these points 
slightly diverging in an almost straight line. The dome of 
the mouth is high and almost square. When articulated, the 
upper central incisors overlap the lower, and are closely 
locked. In general form the teeth are large, the corners 
tending to squareness, and are rather long in proportion to 



nil HEAD. FACE, FAWfi IND mini 



Ivys clqssiftcqfion 
Bilious. 





Sanguinary 




Fig. 1(4. 



Sanguinary should be sanguine. 



336 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

their breadth; in texture they are dense and strong. The 
proximal surfaces are in close contact two-thirds of the dis- 
tance from the cutting edge to the neck, rendering the festoon 
of the gum short and heavy. 

"The sanguine arch resembles a horseshoe in shape. The 
dome of the mouth is high and semi-circular. The articula- 
tion of the teeth is close and firm, and their structure is dense. 
The masticating surfaces of teeth in this class frequently bite 
edge to edge, and as age advances they are gradually worn 
down to the gum unless protected by artificial means. In 
general form they are well proportioned, length predomi- 
nating in less degree over breadth, and their outlines are 
rounded and curved. The distal and mesial surfaces are in 
contact a little more than half the distance from the cutting 
edge, and the festoon is long and delicate in outline. 

"The arch of the nervous temperament presents a strong 
contrast to either of the two preceding, and is sometimes 
spoken of as Gothic, from its pointed character. From the 
central incisors, which often overlap for want of space, the 
line of the remaining teeth continues backward with a slight 
curve, the greatest prominence being between the cuspid and 
the first bicuspid. The roof of the mouth partakes of the 
same curve and angle as the arch. The articulation of the 
teeth is not close but long, and the teeth belonging to this 
temperament are of average density and structure. In shape, 
length predominates over breadth; the distal corner of the 
centrals is rounded, giving the whole tooth almost the appear- 
ance of a lateral, and the cusps and cutting edges are long 
and fine. The point of contact of the proximal surfaces is 
near the cutting edge, giving a long, delicate festoon to the 
gum. 

' 'The lymphatic arch is almost semi-circular in its outline, 
and somewhat resembles that of the sanguine temperament. 
The dome, or roof of the mouth, is flat and low. The articu- 
lation is irregular, and the front teeth are apt to protrude. 
In shape, breadth predominates over length, and the normal 
depressions and elevations are either entirely absent or unde- 
fined. The festoon of the gum is thick and indefinite in out- 



1 III III \l>. I \< I . JAWti \M' I I I.I II 

liue. The lateral on either or both sides is frequently oat 
oi line. M 

This classification would seem on general principle 
possess some merit, but upon close observation it will not 
hold good. 

The temperament, as far as the shap . Bize and chai 
of the jaws and teeth are oonoerned, has nothing whatever to 
do with it. and the vault, least of all. cannot share in any such 
division. 

In mouths *>i the bilious, sanguine, nervous or lym- 
phatic temperaments we can find dental arches in each tem- 
perament measuring 2.50 aero-- from the inner surface o\ 

•i i bicuspid 'to the inner surface of the other. We can 
also find tin* dental arch ranging all the way down to .96 in 
width, and the anteroposterior diameter ranging from L86 
to 2.43. The vaults must necessarily range in height and 
shape to correspond to the width and length of the dental 
arch. 

It is easy to see why temperament has very little to <lo 
with the shape of the dental arch. Two individuals are mar- 
ried, one a nervous, the other a lymphatic, bilious, or san- 
guine temperament: the offspring inherit- the jaws of one, 
the teeth i^ the other, and the temperament of the child is 
changed. The local condition is such that the shape of the 
jaw may change the character of the vault entirely. ( me child 
may possess a broad dental arch, but very short, another a 
very narrow and long dental arch. Hence, classifying the 
dental arch and vault with temperament i- wholly out of the 
question. 

That it may not seem presumptuous on my part to advance 
such positive assertions, let us examine the individuals from 
which tin- following drawings were taken and compare the 
temperaments with the anteroposterior and lateral outline-. 

In selecting the temperament I was governed by the 
description of each as laid down in the article by Ivy in 
J erican System of Dentistry. I did not. however, rely 
entirely upon my own judgment, but called to my assistance 
a physician of Btanding and ability. 



33S ETIOLOGY OF OSSEOUS DEFORMITIES OF 

Under the heads brachycephalic, mesencephalic and doli- 
chocephalic, there are sixty drawings (Plates 19 to 28) from 
models of white individuals. The height of vault varies from 
.31 to .81, with a width from 1 to 1.86; the antero-posterior 
ranges from 1. ST to 2.50. 

In examining the drawings, in outline, they are as differ- 
ent as it is possible to make them and not produce a deformity. 
Thus, in the antero-posterior direction, Figs. 1 and 7 (Plates 
19 and 21), brachycephalic, with only a difference of .03 in 
width of head, has its highest part in the vault about the 
second molar, while Fig. 6 (Plate 19) has its highest at the 
first and second bicuspids. Fig. 6 (Plate 23), mesocephalic, 
has its highest part midway between the highest part of 
Figs. 6 and 7, brachycephalic. 

Looking at the lateral outline we notice that Figs. 1, 2 
and 6 <Tlate 20), brachycephalic, are pinched or contracted, 
and this contraction is not uniform upon both sides. Figs. 

3 and 7 (Plates 20 and 22), brachycephalic, and Fig. 6 (Plate 
24), mesocephalic, are broad; Figs. 3 and 7 are not uniform 
upon both sides, while the teeth do not stand in the same 
direction — some stand vertical, others at an angle of 45°. 

Figs. 11 and 12 (Plate 22), brachycephalic; Figs. 1, 3 and 

4 (Plate 24), mesocephalic, and Figs. 4 and 5 (Plate 27), 
dolichocephalic, are sanguine. 

Could there be a greater difference possible in comparing 
the antero-posterior and lateral drawings ? Fig. 12 (Plate 
22), is very high at the middle, or about the first permanent 
molar, while Fig. 4 (Plate 23), mesocephalic, and Fig. 4 
(Plate 27), dolichocephalic, are very flat, and the soft palate 
of Fig. 4 (Plate 27), dolichocephalic, extends back consider- 
ably farther than in Fig. 4, mesocephalic. 

Figs. 1, 3, 5 and 11 possess graceful curves, but not on the 
same circle. The teeth also stand at different angles, as in the 
last group. In looking over the lateral drawings, Fig. 4, meso- 
cephalic, and Fig. 5, dolichocephalic, possess a slight resem- 
blance, although the width and height vary .12 and .31 of an 
inch, respectively. The lowest vault has the widest jaw, 
while the highest vault the narrowest. There is a depression 



i ill" MEAD, FACE, rAW8 \m« i i i i ii 

at the median line, which i- quite marked, in the ant 
posterior drawing, Fig. i. meaooephalic, thai ifl not in the 
other. The sides of the arch in Fig. I. meaooephalic, div< 
tt» a greater extent than those in I dolichocephalic. 

Thus m a general way no two resemble each other. 

It is claimed bj some that the neurotic possess the high 
est vaults. Let us see how tar this can be carried out. Figs. 3, 
9 and i<>, brachy cephalic; Figs. 2, 7 and LO, meaooephalic; Figs. 
l ami ♦'», dolichocephalic, possess a nervo bilious or neurotic 
temperament. We have the extreme highest vault. 7."-, and the 
extreme lowest . 37. In the lateral measurement the extreme 
narrowest, I, and the extreme widest, 2.50. As far as 
the shape of the dental arch and teeth are concerned, my 
observation does not correspond with Ivy's in the least 
degree. 

To illustrate the wide difference in two individuals of the 
same temperament, let us take Figs. 3 and \. mesocephalic 
— both medical students, and of sanguine temperament. 
Fig. 3 weighs L95 pounds, Is six feet two inches, while F 
weighs L63-j pounds, and is five feet eight Inches. Both 
measure seventy-nine lateral index. The two head- are 
exactly alike. The width of vault in Fig. 3 is 1: Fig. I. I 
Height of vault Fig. 3, .•"' , '-; Fi<z. 4. .50. The -mailer man 
possesses the widest and lowest arch. The shape of the den- 
tal arch, the gums and teeth, are wholly unlike. The 
-mailer man has the larger teeth, while the gums are long 
and pointed. The larger man has short, broad gums. 

There were only three lymphatic individual-. Fig. 5 
(Plate 20), brachycephalic; Fig. 9 (Plate 26), mesocephalic, 
and Fig. 3 i Plate 27), dolichocephalic. Fig. 5 possesses height 
of vault. .62; Fig. 9, .44; and Fig. 3, .7.'-: while the width of 
vault is, Fig. 5, L.25; Fig. 9, 1. and Fig. 3, 1.25. 

In looking over the drawings, I find none resembling 
Ivy'- illustrations, nor do any look alike. It will, then: 
be noticed that the same rule holds good in the lymphatic 

temperament as in all others, that there L8 no uniformity in 
shape, -ize or height 



340 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

SHAPE OF THE VAULT COMPARED WITH THE SHAPE OF THE 

HEAD. 

It has been stated that the shape of the vault resembles 
the shape, or contour, of the head. Thus a brachycephalic, 
or broad head, contains a large, broad jaw with a low vault, 
while a dolichocephalic, or long, narrow, high head, pos- 
sesses a long, narrow jaw with a high vault. In order to 
study the relation of the shape of the vault with the contour 
of the head, a large number of models were secured, and 
measurements of the head taken. The shape of the jaws 
were taken in modeling compound in such a manner that the 
soft palate could also be outlined. From these impressions 
plaster models were obtained, measurements then taken, and 
the models sawed at the median line. One half was placed 
upon paper and an outline obtained. The two halves were 
then glued together and the saw passed through the model 
laterally between the second bicuspid and first permanent 
molar. The anterior half was then outlined. 

The shape of the head was obtained by the use of a heavy 
strip of lead carefully moulded to the head in the antero- 
posterior direction from the nose to the base of the skull, then 
removed, laid upon paper, and outlined. The lateral contour 
was obtained by moulding the lead over the* head, just back 
of the ears. These outlines were reduced by means of the 
pantagraph to about one third the natural size. Unfortu- 
nately, craniologists are not yet in accord as to the best 
method of taking the measurement of the head. This want 
of harmony precludes uniformity of action in deciding what 
shall constitute a broad head and a long head. 

Vogt says, in his work on man: "Taking the tables of 
Welckeras a basis, and assuming the longitudinal diameter of 
the skull — 100, the following results are obtained for the 
various races; where the mean of the transverse diameter is 
below 72, they may be termed long heads; where it exceeds 
81, short heads; where it varies, between 74 and 81, middle 
heads." 



I III II I \l». 1 \< I . I \W - \M ' I I I I II 

BR< N k'fl l'l \ [814 »n i 1:1 \' 

l . True dolichocephalic, belo^ . 

s»ii» dolichocephalic, 750 to 778. 

:;. Mesocephalic, - 77- to 800. 
\. Suh brachycephalic, BOO to 3 

True brachy cephalic, - abov< 

Professor Flower, of the Royal College of Surgeons, 
gland, simplifies this table by the following: 

Dolichocephalic, - - - belofi 7 

Ifesocephalic, 750 to vm ". 

Brachycephalic, - - - above BOO, 

I adopted the rule of Flower, for the reason thai the dif- 
ference between the broad heads and the 1 « ► 1 1 ir heads is more 
pronounced. I could more easily distinguish any deviation 
that might exist between the vault and the shape of the 
head. 

This measurement was also taken with the instrument used 
by hatters. I found it of no value, however, except to give 
an outlined demonstration of the shape of the circumference 
of the head. I secured model- and measurements of the 
heads of white and colored person-, BO that I might note any 
deviation In the shape of the heads of the two races, should 
there be any. and for another reason which I shall explain 
further on. I found it very difficult to pick out individuals 
possessing brachycephalic, mesocephalic, and dolichocephalic 
lead-; that i-. I could not decide until the measurement of 
the head was taken, whether it was a proper case or not I, 
therefore, invariably took the measurement of the head first 

It may seem an easy matter to secure individuals with 
lateral indexes below 7«». or longheads, especially among col- 
ored people, since they have been classed by craniologists as 
a Long-headed race, but when I state that I spent my noon 
hour for over three months visiting the hotels and restaur- 
ants in Chicago with a view of securing twelve, and was only 
able to obtain six. we can have some idea of the scarcity of 
these persons. When they were found, it required the 



342 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

greatest amount of tact to get them to come to my office for 
the examination, owing to their sensitive nature. 

It is a singular fact that the dolichocephalic head of the 
negro has been changed in this country to a mesocephalic and 
even brachycephalic head by climate, soil and the mixture of 
white and Indian blood. Hundreds of heads measuring over 
75 could be found, when only one below TO was obtained. To 
find white dolichocephalic heads w T as still more difficult. I 
have sufficient, however, for the purpose which required 
them. The children were classified according to their ages, 
and in most cases with the broad heads at the top of the list. 
This plan, however, was not always carried out, but by 
referring to the lateral index number, they can easily be com- 
pared. We could hardly expect to find a uniformity between 
the contour of the vault and the head (if such a thing were 
possible) before the twelfth year, because both head and 
vault are undergoing the formative process. They are given, 
however, for the purpose of showing the changes that do 
take place in the transitory period. 

Below is given a description of the diagram of the shapes 
of the vaults of forty-eight adults,* white and colored; tw r elve 
brachycephalic (Plates 19, 20, 21 and 22); twelve mesocephalic 
(Plates 23, 24, 25 and 26); six dolichocephalic (Plates 27 
and 28), white; and six brachycephalic, six mesocephalic and 
six dolichocephalic (Plates 29 to 34), colored. The index 
width outside first permanent molar, width outside second 
bicuspid, width inside second bicuspid, antero -posterior 
measurement when the third molar w 7 as present, height of 
vault, and temperament were noted. 

The special instruments already described w T ere used for 
the last two measurements, for the reason that in the antero- 
posterior measurement frequently only one third molar was 
present, or a tooth anterior to the third molar might have 
been extracted, in which case the third molar upon that side 
would have moved forward. In such case the T-square (Fig. 10) 
when placed upon the posterior surface of the furthermost 
third molar, and the long arm brought forward to a point 

* The shapes of the heads were taken, but are not illustrated in this work. 



I ill ill \i>. FACE, JAWS wi> i i i i ii 

between tin* central incisors, n very Accurate measurement 
could then !)«• obtained. The vault varies bo much in height 
ai different localities that, in order to obtain the measure 
ment at thehigheat part, it was necessary to invent aninstru 
incut that could be moved backward, forward and at any 
angle, In order that these points could be reached, and at the 
Bame time have a fixed point (the alveolar process between 
the second bicuspids and first permanent molars to -tart 
from. 

The Instrument Is illustrated in Fig. LI. The figures I. 

. etc., together with the same figures of antero posterior 
and lateral diameter of the mouth, correspond to the same 
individual; upon close examination, there is not the slightest 
resemblance between them. Occasionally, by a stretch of the 
imagination, we think that we can discover a slight simi- 
larity, but upon a critical examination there is no resem 
blance. Let us now examine the extreme in the brachy 
cephalic (Plates 19, 20, _l and 22) and dolichocephalic (Plates 
27 and 28 

If we cannot find a uniformity in the vault and contour of 
the heads of these individuals, we certainly cannot expect to 
find them in the mesocephalic individual- (Plates 23, 24, 

25 and 26). 



344 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



TEMPERAMENT. 




Nervo sanguine 
Nervo-sanguine 

Nervo sanguine 

Nervo bilious 

Lympho-sanguine 

Sanguino-bilious 

Nervo sanguine 

Nervo-bilious 

Nervous 

Nervous 

Sanguine 

Sanguine 


HEIGHT OF 
VAULT. 




r- c: c T' -• os ?■ — ■- 

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2.37 

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2.18 
1.87 

2 . 50 
2.25 
2 1 2 


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346 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

BRACHYCEPHALIC — COLORED. 



NO. 


INDEX 


WIDTH O TTT- 
SIDE 1ST MO- 
LAR. 


WIDTH OUT- 
SIDE 2d BI- 
CUSPIDS. 


WIDTH BE- 
TWEEN 2d 
BICUSPIDS. 


ANTERO- POS- 
TERIOR. 


H E I G HT OF 
VAULT. 




In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


In. j Mm. 


In. 


Mm. 


1 


87 


2.87 


72.90 


2.00 


50.80 


1.31 


:;:;.-j; 


2.18 


55.37 


0.56 


L4.22 


2 


87 


2.50 


63.50 


2.35 


5 7 ■ I 5 


1.62 


41.15 


2.12 


53.84 


0.50 


12.70 


3 


85 


2.37 


60.20 


•.'.mi 


50.80 


1.37 


34.77 







0.62 


15.74 


4 


84 


2.25 


57. ] 5 


2.00 


50.80 


1.31 


33.27 


2.00 


50.80 


0.75 


19.05 


5 


84 


2.50 


63.50 


2.12 


53.84 


2.50 


03.50 


2.25 


57.15 


050 


12.70 


6 


81 


2.50 


63.50 


2.00 


50.80 


1.37 


34.79 


2.25 


57.15 


0.75 


19.05 



MESOCEPHALIC — COLORED. 



NO. 


INDEX 


1 


80 


o 


79 


3 


79 


4 


78 


5 


78 


6 


75 



WIDTH OUT- 
SIDE 1st MO- 
LAR. 



In. 

2.50 
2.81 
2.25 
2.50 
2.12 
2.37 



Mi 



63.50 
71.37 
57.15 
63.50 
53.84 
60.20 



WIDTH OUT- 
SIDE 2D BI- 
CUSPIDS. 



In. 



2.25 
2.50 

2.00 
2.50 
1.50 

2.00 



Mm. 



57.15 
63.50 
50.80 
63.50 
38.10 
50.80 



WIDTH BE- 
TWEEN 2d 
BICUSPIDS. 



In. 



1.62 
1.62 
1.50 

l.r.o 
1.31 
1.37 



Mm. 



41.15 
41.15 
38.10 
38.10 
33.27 
34.79 



ANTERO- POS- 
TERIOR. 



In. 



2.31 
2.25 
2.00 

2.37 
2.12 



Mm. 



58.67 
57.15 
50.80 
60.20 
53.84 



H E I G HT OF 
VAULT. 



In. 



0.62 
0.62 
0.02 
0.02 
0.02 
0.50 



Mm. 



15.74 
15.74 
15.74 
15.74 
15.74 
12.70 



DOLICHOCEPHALIC — COLORED. 



NO. 


INDEX 


WIDTH OUT- 
SIDE 1st MO- 
LAR. 


WIDTH OUT- 
SIDE 2d BI- 
CUSPIDS. 


WIDTH BE- 
TWEEN 2d 
BICUSPIDS. 


ANTEBO-P O S- 
TERIOR. 


H E I G HT OF 
VAULT. 




In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


1 


70 


2.12 


53.84 


1.87 


47.49 


1.18 


29.'. IT 


2.18 


55.37 


0.50 


14.22 


o 


09 


2.50 


03.50 


2.12 


53.84 


1.50 


38.10 


2.25 


57.15 


0.02 


15.74 


3 


07 


2.50 


03.50 


2.18 


55.37 


L.50 


38.10 


2.25 


57.15 


0.02 


15.74 


4 


07 


2.25 


57.15 


2.00 


50.80 


1.18 


29.97 


2.25 


57.15 


0.02 


15.74 


5 


03 


2.25 


57.15 


2.12 


53.84 


1.50 


38.10 


2.25 


57.15 


0.62 


15.74 





00 


2.50 


03.50 


2.25 


57.15 


1.75 


44.45 


2.37 


00.20 


0.68 


17.27 



BRACHYCEPHALIC, AVERAGE — WHITE AND COLORED. 



RACE. 


WIDTH O U T- 
SIDE 1ST MO- 
LAR. 


WIDTH O U T- 
SIDE 2D BI- 
CUSPIDS. 


WIDTH IN- 
SIDE 2d BI- 
CUSPIDS. 


ANTERO-PO S- 
TEKIOR. 


H E I G HT OF 

VAULT. 




In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


White .... 
Colored . . . 


2.33 


56.38 

59.18 


L.98 

2.06 


50.29 

52.32 


1.19 
1.53 


30.22 
38.86 


2.1.0 
2.16 


54.80 


(i 54 
0.01 


13.71 
15.49 



Till HIM'. FACE, JAWS \M> I I I I II 



MES< m i i-il \i.|i , w I'l: \'.l 



WHIM \ \l 



1:1 I 



R \< 


W 1 1 > I 1 1 < > 1 1 

: n Mi ■ 


U I 1 » I 1 1 < • 1 1 

UDl 

i i n n>-. 


U 1 I > 1 1 1 IN 

-ii.i 2D hi 
. i -in.-. 


\N 1 1 


hi '.i 
VAULT, 




In. Mm. 


In. 


Mm. 


In. 


Mm. 


111. 


Mi... 


In. 




.... 
I 


". " l 




1.95 
2.12 




L.16 

l. L9 




2.18 
2.16 






• 



DOLN IK '< llll M.n . w ERAGE u III I I 4ND COD >RED 



\i.V 


w 1 1 > 1 1 1 01 i 

bidi lea MO- 


w 1 1 > 1 1 1 01 i 

mix. 2d bi- 


\\ II > I 1 1 IN 

-ii> i 2d hi- 
1 1 -III.-. 


HOB. 


H1IOB1 ") 




In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


In. 


Mm. 


White 

Colored.. . 


3.19 


55.62 

-)'.t.f,«.t 


1.97 
2.09 


50.03 


L.50 
1.42 


:;<•..< if, 


2.18 
2.2G 


57.40 


n.Tl 
0.62 


1 8 . 7'.' 
15.74 



Upon examination of the figures of the brachycephalic, 
white tlu' first six lateral indexes are 84. Taking the width 
oi the denta] arch we find that it varies from 2.12 to 2.62; 
outside second bicuspids, from L.75 to 2.37; width of vault 
between second bicuspids, from l to L.37; antero-posterior, 
from L.87 to 2.37, while the height of the vault varies from 
.H to .62. In the mesocephalic, white, the range varies from 
2 to 2.50 in width of dental arch; width outside of second 
bicuspids, from L.62 to 2.25; width inside second bicuspids, 
from 1 to 1.86; antero-posterior, from 2 to 2. 37, and height 
of vault, from .31 to .68. Dolichocephalic: The range width 
of dental arch is from 2 to 2.37; width outside second bicus- 
pids, l. v 7 to 2.12; width between second bicuspids, from L.25 
to 1.50; antero-posterior, from 2.12 to 2.31; height ^f vault, 
from .62 to .81. 

The range of figures in each group is bo great, and differs 
SO much from each other, that it will be impossible to say 
that any two possess the slightest resemblance to each other. 
By comparing one group with another, it will be seen that 
there is very little difference a- regards width and length of 
dental arch, and width of vault. There is. however, quite a 
difference in height of vault. 



348 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

By comparing the figures in the table of the lateral index, 
we do not observe the slightest resemblance in width, height 
or temperament, nor can we observe the slightest resemblance 
in the contour of the vault and head. It has been claimed that 
the shape of the vault is influenced by the intellect of the indi- 
vidual; that is, the most intellectual people possess the 
highest vaults. With a view of ascertaining the correctness 
of this theory, I measured the heads of six brachycephalic 
(Plates 29 and 30), six mesocephalic (Plates 31 and 32), and six 
dolichocephalic (Plates 33 and 34), colored people — waiters in 
hotels and restaurants. The white people examined con- 
sisted of bankers, editors, medical men, students, architects, 
bookkeepers — in fact, the most intelligent men that I could 
find. 

By comparing the brachycephalic heads we notice that 
the highest lateral index in the white individuals is ^>4. in 
colored 87. The highest width, outside of first permanent 
molar, is white 2.62. colored 2.87. This seemed to me quite 
remarkable. The lowest white 2, colored 2.25. In width of 
vault, between second bicuspids, highest, white 1.37, colored 
1.62; lowest, white 1, colored 1.31. Antero-posterior, greatest 
length, white 2.50, colored 2.25. Height of vault, highest 
white 68, lowest 37, with an average of 54; colored highest 
75, lowest 50, with an average of 61. 

Mesocephalic — Highest lateral index, white 79, colored 
80. Highest width outside first permanent molar, white 
2.50, colored 2.81; lowest, white 2, colored 2.12. Width of 
vault between second bicuspids, highest, white 1.86, colored 
1.62; lowest, white 1, colored 1.31. Antero-posterior, highest, 
white 2.37, colored 2.37; lowest, white 2, colored 2. Height 
of vault, highest, white .68, colored .62; lowest, wdiite .31, 
colored .50; average, white .52, colored .60. 

Dolichocephalic — Highest lateral index, white 72, colored 
70. Greatest width outside first molar, white 2.37, colored 
2.50; lowest, white 2, colored 2.12. Width of vault between 
second bicuspids, highest, white 1.50, colored 1.75; lowest, 
white 1.25, colored 1.18. 

Antero-posterior — Greatest length, white 2.31, colored 



I 111 111 \l», I M I . .1 \w - \M» I I I I II 



smallest, white 2.12, oolored 2.18. Height of vault, 
highest, white .81, oolored .68; lowest, white .62, colored 
while . 7 1, colored I 

In reviewing the figures we notice thai the colored people 
ss the roundest heads, while the width of jaw is larger 
in white, but in the other divisions the jaws are more uni 
form in width. 

A point which must oot be lost Bight of, and one that I 
have frequently noticed in ancient Bkulls, is that in the 
colored race the jaw does not diminish in width anterior to 
the first permanent molar as it does In the white race. The 
height of vault seems to be much higher in the colored race 
than in the white, with the exception of the dolichocephalic 
heads, where it Is higher in the white race. The height of 
vault, like other measurements, is more uniform in the white 
race. Comparing the figures of the colored with white people, 
it will be seen, in the average, that the width and antero- 
posterior measurements of the colored people are the largest 

Since the highest vault- in the brach ycephalic and nie-o- 
cephalic head- are found among colored people, and in the 
dolichocephalic among the white, we must conclude that 
intelligence has nothing whatever to do with the contour of 
the vault, and that there is no more comparison between the 
vault and the contour of the heads of colored people than 
there is in white individuals. 

IIOC rH-BBEATHING \<>T THE CAUSE OF CONTRACTED JAWS \M> 

IlhiH VAULTS. 

One of the theories which has been advanced as a cause of 
high vault-, and one that is still held to by some dentists and 
many medical men. is that of mouth-breathing. Mouth - 
breathing is caused by sleeping with the mouth open, by 
enlarged tonsil-, by adenoid growth, by hypertrophy of the 
mucous membrane of the nose and turbinated hones, and by 
arrest of development of the bones of the jaw and nose. It is 
claimed by these men that when the mouth i- opened, pr« — 
ure is produced upon the sides of the jaw- and teeth by the 
tension of the buccinator muscle, causing a contraction of the 



350 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

sides of the jaw, a protrusion of the teeth, and an elevation 
of the vault. 

I will direct attention to a few facts as they have been 
presented to me during a constant study of the deformities of 
the jaws and teeth for the past eighteen years. 

In the first place, let us consider the parts involved. The 
superior maxillary bones are fused at the median line. Their 
under surfaces have imposed upon them the alveolar pro- 
cesses. The maxillary bones proper are made up of dense, 
compact tissue, and are so arranged as to best resist certain 
forces. The outer surface of the bone is fortified and sup- 
ported by the malar process, which is situated midway 
between the maxillary process and the canine eminence at 
the first permanent molar. At the canine eminence we have 
the strong, thick plate of bone extending from the bridge of 
the nose to the ala?, the mesial portion forming the outer sur- 
face of the nasal cavity. We also observe that the nasal sep- 
tum is situated at the center of the nares and is attached to 
the maxillary bone at and along the place of union of the 
two halves of the maxillary bone. A saw passed through 
from one canine fossa to the other discloses in the section the 
strong trilateral pillars of bone which go to make up the outer 
surfaces of the nasal cavity. These strong pillars of bone 
are situated just at the point of the location of the permanent 
cuspids, and. together with the nasal septum, form a strong 
support to the hard palate. 

The maxillary bones are for the attachment of muscles 
and the resistance of force in masticating food. The hard 
palate does not assume the normal shape until the twelfth 
year, or after the teeth are all in position. The vault may 
be high or low, ranging from one inch vertically from the 
alveolar plane on a tranverse line intersecting the alveolar 
crests between the second bicuspids and first molars (which 
is the highest vault I have seen) down to one quarter of an 
inch from the same plane (which is the lowest vault I have 
observed). In either case the vault may be normal; each 
variety depending upon the shape of the maxillary bones 
and teeth for its peculiar form. 



hie 



ii \i ', i \< i . i w\ 



wi> 1 1 i i ii 



351 



The alveolar process, on the other hand, ifl made up «»t 
soft cancellated structure, and is solely for tin- pu 
protecting the germs of the teeth before the} have erupt 
and for supporting tin- teeth after they are in place in the 
jaw. From the time the teeth make their first appearance 
until they an- finally Bhed, the alveolar process has de\ eloped 
and been absorbed three distinct times. Thev-alveolar pro- 
cess being therefore solely for the protection anil Bupport of 
tin' teeth, it i- logical to inter that the position and shape "t 
thr alveolar process depend upon the location <>f thr teeth. 
The hone proper, therefore, a- we -hall see later, i- not 




influenced to any great extent by the movement of the teeth. 
Tin- buccinator muscle is composed <>t" Btriated muscular 

fibers, and i- therefore under the. control of the will. It i< 
penniform in shape. It has its origin and insertion alongthe 
body of the jaws, above the alveolar process OH the upper 
and below the alveolar process on the lower jaw. It extends 
from the first bicuspid anteriorly to the wisdom-tooth pos- 
teriorly. The center of the muscle in one direction therefore 
would he on a line with the grindmg-surface of the teeth, and 
in a tranverse direction at the first permanent molar. It 
serves to compress air in the act of 1 (lowing, whence it- name. 



352 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

It- chief function is to convey and hold the food under the 
teeth during mastication. 

There are many cases of contracted arches and high vaults 
where mouth-breathing does not exist; there are also many 
cases of normal arches and vaults where it is present. As 
many are aware, mouth-breathing frequently commences very 
early in life; contracted jaAVS, on the other hand, never begin 
to form until the seventh or eighth, and in most cases the 
tenth year, except in cases of monstrosities, or from trau- 
matic causes. When these conditions exist, they are wholly 
unlike the usual contracted arches and can be diagnosticated 




Fig. 106. 



at once, and therefore they should not enter into this discus- 
sion. Contracted arches are of two kinds — V (Fig. 105) and 
saddle-shaped (Fig. 106) — all the other varieties being modifi- 
cations and blendings of these two. It is apparent that the 
cause which produces the one does not produce the other. My 
observation has been that there are two-thirds more V and 
saddle-shaped arches among the low vaults than among the 
high vaults, taking .58 of an inch as the average; but where 
one of these deformities exists with a high vault it is always 
more marked, for the reason that in the high vault the 
alveolar process is long and thin, with very little resistance. 



nil HEAD, FACE, JAWS AND TEETH 

And ili«' teeth we more easily curried in one direction or the 
other. 

In the V shaped arch, commencing at the first permam nt 
molar, there is a gradual narrowing of the dental arch and 
alveolar process toward the median line, where the incisors 
may approximate a V point or m.i\ stand In their normal 
position to each other. Invariably there is a protrusion of 
the teeth and alveolar process, and not of the jaw. < )n the 
other hand, in the saddle-shaped arch the bicuspids are car 
ried inward and the deform it} is invariably situated between 
tin' first permanent molar and the cuspid. Unlike the \ 
Bhaped variety . the anterior teeth and alveolar process nei er 
protrude in this class of deformities. The contracted hard 

palate is always associated with the V-shaped variety, and in 

most cases extends backward to the second bicuspid. It is 
never seen with the -addle shaped variety. 

The high vault is never seen in the first set of teeth, nor 
iUh^ it develop until the second set are all in place, which is 
at the twelfth year. The vault commences to slope slightly 
from the neck of the incisor until it reaches an imaginary 
line drawn across the roof of the mouth from the right first 
bicuspid to the left first bicuspid, and then it gradually or 
abruptly slopes upward until a point is reached which is cen- 
tral and vertical to a line drawn across the jaw from crest lo 
crest between the second bicuspids and first molars. From 
this point posteriorly to the soft palate the dome is usually 
nearly level and parallel with the plane of the alveolar crests 
of the bicuspids and molars when it gradually slopes and 
unites with the soft palate. Occasionally we see a slight 
relative depression, and occasionally a corresponding slight 
elevation, hut these are bo inconsiderable as t" escape notice 
unless one were looking for the peculiarity. 

In mouth-breathing the lower jaw usually drop- only suf 
ficiently for the passage of the same volume of air that would 
pass through the nasal cavities when in a normal condition, 
each of the openings to which is equal to only about one-half 
an inch in transverse area. Old people often sleep with the 
mouth open and frequently to the fullest extent, hut these 



354 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

deformities of the jaws and teeth never occur after the erup- 
tion of the teeth, say at the twelfth or fifteenth year. 

When one opens his mouth he is conscious of a tension of 
the orbicularis oris, but not of a pressure of the buccinator, 
no matter how wide the mouth may be opened. This muscle 
being under the control of the will, is always passive except 
in the act of blowing or eating; therefore contraction during 
sleep is wholly out of the question. As the buccinator muscle 
extends anteriorly to the first bicuspid only, it cannot be pro- 
ductive of the Y-shaped variety of deformity, in which is also 
found the contracted vault. Therefore the only deformity 
that is likely to be so produced is the saddle-shaped variety, 
which is, in fact, out of the question for reasons which I shall 
explain later. The orbicularis oris muscle cannot produce 
the contraction, because when the mouth is open the pressure 
exerted on the six anterior teeth is backward. Thus the teeth 
should be carried in the opposite direction from that which 
must be taken to produce this deformity. Again, the pres- 
sure is just as great upon the incisors as upon the cuspids, 
thus holding them in place. More force is exerted by the 
orbicularis oris upon the six anterior teeth when the mouth 
is open than could be exerted, were it possible, by the bucci- 
nator muscle, which would tend to hold the anterior teeth in 
place. It has in years past been demonstrated by dentists, in 
regulating teeth, that it is very rare for the apices of the roots 
of teeth to move when pressure is brought to bear upon their 
crowns for the purpose of regulating them. This being the 
case, teeth having long roots like the cuspids are less liable 
to move than teeth with short roots like the lateral incisors 
and bicuspids. Since in the moving of a tooth the greatest 
change which takes place is at the neck, it stands to reason 
that the greatest absorption and deposition of bone takes 
place at that point. The roots of the cuspids are larger and 
longer than those of any other teeth in the jaw; unlike other 
teeth, the germs are situated considerably higher and farther 
toward the outside of the alveolar process, so that when they 
come closely into position they diverge from the apices to the 
crowns, while all the other teeth stand nearly or quite perpen- 



I III 111 \|.. PACK. JAWH Wl> I I I I II 






dicular, thus showing thai tin- roots oi these teeth <!<» n<»t 
influence the hard palate. I have shown that the first perms 
aent molar and the teeth posterior to it are never involved, 
pt from local causes. I have also shown that the center 
of ilif buccinator muscle in i»<>th directions is located ;ii this 
tooth. Bow, then, is it possible, Bince all the teeth are 
covered by the muscle upon one Bide, thai half are carried 
inward and the other half remain normal? 

Again, if mouth-breathing is the cause of the contraction, 
both Bides Bhould contract alike, and the deformity be uni- 
form upon both Bides, which is never the case. By observing 
the figure the want oi uniformity <>i the two Bides is easily 



•"" — ^m^^. 



/• 







Fig. L07 



observed. Such muscles do not contract to a degree suffi- 
cient to induce the pressure necessary to produce a deformity . 
That they should, is inconsistent with our knowledge of the 
influence exerted by muscular structure in other part- of the 
body. Some of the muscles of the chest exert much more 
pressure in respiration than it is possible for the buccinator 
to do during sleep, yet no one would expect to find the ril>s 
modified by this process. The pressure of the contractile 
tissue upon the crown- of teeth is oot sufficient to affect the 
alveolar process through the root- <>\' the teeth, but even if it 
could modify that spongy structure, its force would -top there 
and would not extend to the osseous vault and result in bend- 



356 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



ing it out of shape. In most of these cases the diameter of 
the superior maxilla, its alveolar process and teeth, is less than 
that of the inferior maxilla, alveolar process, and teeth. This 
is always the case in the worst forms of irregularities. In 
such cases the muscles and cheek could not press upon the 
teeth and alveolar process of the upper jaw. The changes 
which take place in the bone are not a bending in at one place 
and a forcing out at a weaker point to compensate for the 
space lost, but are an absorption and deposition of bone at 
the point of pressure. And even if such were the case, the 
strong pillar of bone situated at the very point of contraction 










Fig. 108. 



of the alveolar process, together with the nasal septum, con- 
stitute a strong bulwark for resistance to the pressure, which 
is suppositiously acting at a distance from the top of the vault. 
Again, it would be as impossible to so produce pressure suf- 
ficient to break the dental arch as it would be for the weight 
of a building to break the arch of a door or window. The 
tongue exerts a much greater force in the act of swallowing, 
and would prevent inward movement of the teeth if so slight 
a pressure, as the muscles of the cheeks could exert, were the 
cause of the deformity. 

For the sake of the argument, let us suppose it were pos- 



Mil III \l». I \< I . JAW.H Wl> I II I II 






Bible for the buccinator muscle to produce this contraction; 
could then expect to find the modification of the osseous 
structures uniform. This would shut out semi-V-shaped I 
107) and Bemi Baddle shaped arohes Fig. 108) entirely, and ■ 
majority of other irregularities of the teeth in which then 
bilateral asymmetry, for however much one might incline to 
the prevalent theory, no one would dare to assert that the 
muscle will act on one side of the mouth, while that on the 
opposite Bide remains passive. Partial V-shaped (Fig. L09) 
and partial saddle-shaped (Fig. L10) arches make the theory 
still less tenable. In these varieties we meet with Budden 




Wis. I'*' 



Lend- inward where only one or two troth may be involved. 
which aberrations could only be produced by a centralization 
of force on one given point or fiber of muscle, a peculiaritj 
of function that has never yet been ascribed to muscles. The 
muscle being penniform in Bhape, it would be impossible for 
one or two fibers of the muscle to exert their influence upon 
r bicuspid. It would naturally lap over two or more teeth. 
Lastly, if the buccinator acts as all muscles do uniformly 
throughout its extent of contraction it is just a- efficient 
below a median bisecting line in producing a narrow, con- 
tracted arch as in its upper portion, and we should, there- 
fore, expect to find the lower maxilla contracted whenever 



358 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



the upper one is, which is contrary to facts. A V-shaped 
arch can never occur upon the lower jaw, if the teeth articu- 
late normally, because these teeth strike inside of the upper, 
and are thus prevented from moving forward. A saddle, par- 
tial saddle or semi-saddle arch may occur on the lower jaw, but 
these deformities are not often seen. When they do occur, they 
are the result of improper occlusion with the teeth of the 
upper jaw. We always observe in semi-Y and partial 
V-shaped arches that the alveolar process is contracted upon 
the side of the deformity. If one side of the arch is con- 
tracted more than the other, we shall see that the alveolar 
process is contracted in proportion to the amount of deform- 




Fig. 110. 

ity ; the vault on that side is not carried up beyond the other 
side, Avhich is normal. In the saddle, semi-saddle and par- 
tially saddle-shaped arches we find the alveolar process built 
up about the teeth in precise conformity to the nature of the 
shape of the arch. If we take three thousand models of the 
upper jaw and arrange them in groups, according to the forms 
here represented, and then examine very closely the arrange- 
ment of the teeth in each group, we shall be unable to find 
any two alike in either group; thus showing that an external 
force acting upon the jaws from the outside could not possi- 
bly be a cause. If that were possible, all the models of one 
variety would resemble some definite form. • 



I \( I . I \\\ - \\ I • I I I I II 



I 



The following tables will exhibit the difference* in the 
rhts of vaults, both in normal and defective jaws. The 
heighl is taken centrally and vertically from the gingiva] 
plane on a transverse line intersecting the gingival crests 
between the second bicuspids and first molars. For com 
parison with measurements of denuded crania, deduct ."7 for 
the thickness of the soft tissues. Fig. 11 Bhows the instru 
ment used, and the manner of making the measurements. 

v >i;m \i. .1 \w . 





\ 


ghl 


N 


ll< ighl 




l [eighl 








nil. 


i 


■alt. 


1 


• lUlt. 


I 


.21 


1 


. to 


159 






.71 


1 19 




2 




L82 


. 59 


218 


. 75 


127 


.28 


70 




89 


.62 


51 \ 


- 


69 


.3] 


171 


.60 


L99 


.65 


L50 


.-1 






169 


. 


129 


- 


- 


.84 


12 




1 16 


... 










... 



Total number of cases, 4,614. I in inch. 



SADDLE-SHAPED ARCH. 



Height 


\ 


ght 


No. "f 


1 1 sight 


\ 


>. of 


I Icight 


No. of 


of Vault. 




of Vault. 




of Vault. 




ises. 


of Vault. 


Cases. 


.21 




.40 




.56 




6 


.71 


5 






. 13 




.59 




r> 


• 7."> 


5 


.28 




. to 


:: 


.62 




1 


- 


1 


.31 




.50 


:> 


.65 






.81 


1 


.34 






5 


a 






.84 




.37 


1 


... 










• 





Total number ol of an inch. 



\ SHAPED Ai;< ll. 



Height 




Height 


\ . • 


Height 


No. of 


Height 




of Vault. 




of Vault. 


Cases. 


.iiilt. 




of Vault. 


- 


.21 




. 10 


1 




1 5 


.71 


1 






. to 




.59 


4 




• • 


- 




. to 


3 


.62 


9 


a 




.31 


2 


. :,« i 


8 


.65 


• • 


.81 


1 






.53 




- 




.84 




.37 


4 















Total number of cases, 58. \ of an inch. 



:*»;«• 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



SEMI-V AM) SKMI-SADDLE-SHAPED ARCH. 



Height 


No. of 


Height 


No. of 


Height 


No. of 


Height 


No. of 


of Vault. 


Cases. 


of Vault. 


Cases. 


of Vault 


Cases. 


of Vault. 


Cases. 


.21 




.40 




.59 


1 


.7.") 




.25 


1 


.43 


1 


.62 


4 


.78 


1 


.28 




.46 




.65 


2 


.81 




.31 


. . 


.50 


3 


.68 




.84 




.34 




.53 


3 


.71 


g 






.37 


1 




5 











Total number of cases, 24. Average, .56 of an inch. 

In order to strengthen further the views herein suggested. 
I have taken impressions of the mouths of a large number of 
mouth-breathers, and have secured models of the same. 

The following illustrations are from models of the mouths 
of patients over twelve years of age. They number from 
1 to 2-±, in the order in which the impressions were taken. A 
sufficient number of cases are here illustrated to show the 
general outline of the jaws and teeth of the average mouth- 
breather. 

In glancing over these illustrations (which are of natural 
size) it will be noticed that very few have contracted arches; 
as a rule, the vaults are less than the average in height. It 
will also be observed that no two cases are exactly alike, 
which would be the case if the contracted jaws were caused 
by lateral pressure of the cheeks. 

I wish here to acknowledge my grateful obligations to 
Drs. Hawley Brown and Pyncheon, specialists in diseases of 
the nose and throat, for their kindness in sending me their 
private patients. 

Case I, Fig. 111. — Hector M., aged thirteen years; nation- 
ality, French; born in Chicago. Height of vault, .53 of an 
inch. Has always breathed through his mouth. Adenoid 
growth in post-nasal spaces. Collapsed condition of alee nasi. 

Upon examining this cut we observe that the teeth are 
late in erupting, as the patient is thirteen years of age. The 
bicuspids are all through upon the right side and the cuspid 
is just coming into place, while upon the left side the second 
temporary molar is yet in position, the first molar having 



I III II I \I>. PACE, I \w - \M> I I I I II 






just been removed, tod the first bicuspid coming in itfl plsoe. 
The cuspid id not bo far developed as its felloe of theopp 
ride. The second permanent molars Bhould also be in pi 
but tlu'\ are tardy in their development While the general 
contour of the jaw is normal posterior t<» the cuspids, there is 
i tendenoy of the incisors to contraction, w i 1 1 1 a protrusion <>f 
the mesial Burface of the centrals. It will be readily noticed 
that the cuspids are erupting anterior to their normal posi- 
tion, thus crowding the incisors together. 

Case II. Fig. 112. Paul F., aired nineteen years; o 
alitVi American. Height of vault. .75 of an inch. Com 




in. 

menced to breathe through the mouth at the ml:** of nine 
years, at which time his nose was broken. Arrest of devel- 
opment of the bones of the nose. Adenoid growth. Bear- 
ing and eyesight arc poor. 

The jaw of this case is well developed, with a normal 
palate, but higher than the average, being three-fourths of an 
inch in height All the teeth have erupted. The ant 
teeth have a tendency to contraction, due to the fact that all 
the teeth tend to push forward; the central incisors do not 
protrude, as in Case I. because the lateral incisors overlap 
them. The right Bide of the arch tend- toassume the -addle 
shaped deformity, due to the position of the bicuspids, ca 



362 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 






by too long retention of the temporary teeth. It will be 
observed that the two sides are markedly asymmetrical. This 
cut nicely illustrates the point previously mentioned: that if 
contraction of the jaw were due to contraction of muscles in 
mouth-breathing, both sides would be alike. 

Case III, Fig. 113. — Miss Florence T., aged thirteen years; 
nationality, American. Height of vault, .46 of an inch. Had 
scarlet fever at five years of age. Commenced to breathe 
through mouth at the age of eight. Arrest of development 
of the bones of the face and nose. 







Fig. 112. 



This is a well-marked illustration of defective develop- 
ment of the superior maxilla, and also of arrest of develop- 
ment of the bones of the face and nose. As in Case I, the 
second molars have not yet inade their appearance. The 
central incisors overlap, but do not protrude. The right side 
of the arch tends to assume the saddle-shape deformity, due 
to the position of the bicuspids. The cuspid has not fully 
erupted on this side, and is still more tardy in its appearance 
on the left. As is true of Case II, the two sides are asym- 
metrical, and the height of the vault is quite a little less than 
the average. When the second and third molars appear, an 
unusual protrusion of the anterior teeth must necessarily 



i ill ill \i>. FACE, JAW8 w i' i i i I ii 

result m order to give sufficient room for the molars. If this 
i- allowed to progress without mechanical interference 
marked V shaped deformity will result. 

Casj [V, Fig. in Dr. II. S., aged twenty-one v< 
nationality. American. Height of vault, . ,;n of an inch. He 





Fur. 113. 



111. 

has been a mouth-breather all his life. Has deflection of 
the septum nasi, and, at the air*' of fourteen, was operated 

upon without any benefit. The bones of the nose are well 

developed, hut those of the face are slightly arrested. 

While the jaw is not quite as large as the normal jaw. the 

teeth are very regular, finely developed, and without a cavity. 



364 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

It would be rare to find a more nearly perfect arch. The 
articulation with the inferior maxilla is at all points exact, 
and we have here a marked illustration of an orthognathous 
jaw. 

Case V, Fig. 115. — Mr. William M., aged fifty-two years; 
nationality, American. Height of vault, .43 of an inch. 
Always breathed through the mouth. Bones of the nose and 
face well developed. Last year had hypertrophied bone 
removed from the nose. Eyesight and hearing are good. 
The jaw is well developed, and shows no deformity. 

Case VI, Fig. 116. — Miss H. C, aged seventeen years; 



Fig. 115. 

nationality, American. Height of vault, .65 of an inch. Has 
not always breathed through the mouth. Has adenoid growths. 
Has had measles and chicken-pox. 

This jaw is considerably contracted throughout, but it is 
more noticeable through its lateral diameter. The alveolar 
process is hypertrophied on either side, the hypertrophy being 
more marked on the right side. 

Case VII, Fig. 117. — Kate K., aged seventeen years; 
nationality, American. Height of vault, .65 of an inch. Has 
always breathed through the mouth. Has post-nasal catarrh. 
Has had measles and whooping-cough. This jaw was arrested 
in its development, and the first bicuspids have been extracted 
to make room for the other teeth. 



mi HBAD, i 101 , ■' *W8 1KB I I I m 

ll lt . lateral incisors overlap the centrals, due to i tack of 
room before the extraction of the bicuspids. The two 
are asymmetrical, tho left side diverging to alio* the eruption 
of the Beoond molar. 

Cxai \ 'HI. Fig- • ls - Mr. H., aged eighteen years; nation 
alitv, American. Height of vault, .59 oi an inch. II 




Pig. 117. 

always breathed through the mouth. Had Bcarlel fever at 
the age of eighteen months. Received a blow upon the nose 
which caused a deflection of the septum nasito the left The 
lefl nostril is entirely closed by hypertrophy of bone and 
mucous membrane. There is slighl hypertrophy oi the 
mucous membrane of the right nostril, also hypertrophy oi 



366 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



the mucous membrane in the post-nasal space. Arrest of 
development of the bones of the nose. Case VIII is an 
illustration of marked arrest of development of the entire jaw. 
The anterior teeth are much crowded, and on the left side the 
leteral incisor has erupted within the arch; that of the right 
side partially within the arch. The cuspids have erupted 
outside of the arch; on the right side the sixth-year molar has 
been extracted, in consequence of which the second molar 
has pushed forward. 

In this case the small jaw is inherited from the mother 
(whose jaw was unusually small), and is in harmony with the 
bones of the face. The teeth, which are exceedingly large 




Fig. 118. 

and have long roots, are inherited from the father, and are 
so out of proportion to the small jaw that the posterior teeth 
have moved forward and filled the spaces intended for the 
cuspids. 

Case IX, Fig. 119. — Geo. H., medical student, aged 
twenty-five years; nationality, American. Height of vault, 
.71 of an inch. Commenced to breathe through the mouth 
at the age of ten. Marked arrest of development of the 
bones of the face and nose. The nasal cavities are small, and 
the nasal septum is deflected slightly to the right. Hyper- 
trophy of cartilage on the left side; the mucous membrane is 
slightly thickened. The posterior nasal cavities are clean. 



nil in \i». FACE, JAW8 w i» 1 i i i ii 



• 7 



The patient has bad measles, ohicken-pox, mumps, and 
two attacks of pneumonia. Bad severe rheumatism at the 
mm oi twenty-one, and at the present time there is tuber 
eulosis of the left ankle. 

An examination of the jaws revealed the following facts: 
The lower ja* La excessively large; although .-ill of the teeth 
of the lower javt tip inward, yet the outer cusps of the upper 
teeth just touch the inner cusps of the lower teeth. There i- 
marked arrest of development of the upper jaw, and on the 
right Bide the arch has a tendency to assume the saddle-shaped 
deformity. On this side the cuspid has erupted externally 




I-1-. II'.'. 



to the arch and between the central and the lateral incisors; 

it- mesial surface is directed inward. The lateral incisor is 
internal to the other teeth. The lateral Incisor on the left 
side is situated internally to the central incisor and cuspid, 

and has caused a slight rotation of the central inci-or. 'The 
second molar- are small, and have erupted externally to the 
first molar on account of lack of room in the jaw. The 

alveolar process and mucous membrane are hypertrophied. 

This case clearly -how- that at the time of the formation 
of the irregularities of the teeth the alveolar process and 
mucous membrane began to hypertrophy; coincident with 



36 S ETIOLOGY OF OSSEOUS DEFORMITIES OF 

these was arrest of development of the bones of the face, nose 
and jaw, and the habit of mouth-breathing was formed. 

Case X, Fig. 120.— Mr. William S., aged thirty-four 
years; nationality, German. Height of vault, .71 of an inch. 
Has always breathed through the mouth until an operation 
four years ago. He had scarlet fever and measles. 

As will be observed, by examining the cut, this jaw is well 
developed. The central incisors overlap slightly, due to Rigg's 
disease. The left side has a tendency to assume the saddle- 
shaped deformity, due to the position of the bicuspids, which 




Fig. 120. 

was probably assumed on account of the too long retention of 
the temporary teeth. The crowns of the molars have decayed 
and broken off. The thickening of the mucous membrane is 
the result of Rigg's disease. 

Case XI, Fig. 121. — M. W., aged thirteen years; nation- 
ality, American. Height of vault, .62 of an inch. Has 
breathed through the mouth for the past six years. There is 
arrest of development of the bones of the face and nose. The 
patient has considerable catarrh. Is now under treatment 
for irregularities of the teeth. The jaw is much contracted, 
especially in the anterior part. On the right side the lateral 
incisor is deformed, and is represented by a* conical tooth situ- 



I II I III \l». I \< I . I \ \N 



\\H I I I I II 






ated internal lj to the other teeth. Posterior to this ia the 
temporary cuspid; on account of the retention of this tooth 
the permanent cuspid is erupting externally to the other 
teeth and between the temporary cuspid and permanent cen 
tral Incisor. On the left Bide the lateral incisor ia deformed 
in a similar manner to thai on the right, but ita position is 
normal. The temporary cuspid on the lefH Bide remains. 
Owing to the fact that there wraa insufficient mom in the jaw 
for the aeoond molars, the teeth anterior to these moved 
forward, producing the V Bhaped projection of the central 
incisors. 




Pig. 121. 



Case XII. Fig. 122. — Charles I)., aged fifteen year-; 
nationality. American. Height of vault. .53 of an inch. 
Deflection of septum nasi, and thickening of mucous mem 

brane. The patient has always breathed through the mouth. 
This case is similar to Case VIII, in that the small jaw 

is inherited from the mother, and the Large teeth from the 
father. 'The dental arch is contracted .-Ulterior to the CUS- 
pids, and the anterior teeth are crowded: posterior t<> the .li- 
pid- the dental arch i- normal. The first bicuspid on the 
left side baa been removed to afford more room for the other 
teeth: the corresponding tooth on the right side should also 
have been removed. The fact that it was allowed to remain 



370 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



caused a crowded condition on that side, and the incisor has 
passed beyond the median line of the jaw, encroaching upon 
the other side. Owing to there being insufficient room in the 
jaw for the second molars, the teeth anterior to these have 
pushed forward, producing the V-shaped protrusion of the 
central incisors. 

Case XIII, Fig. 123.— Mr. H. B., aged twenty years; 

nationality, . Height of vault, .71 of an inch. Has 

always breathed through the mouth. The alveolar process 
is well developed, but the maxillary bones are arrested in 
their development. The left nostril is entirely closed. There 




Fig. 122. 

is hypertrophy of the mucous membrane of the right nostril. 
Has had scarlet fever and whooping-cough. 

Although there is arrested development of the maxillary 
bones in this case, no deformity is produced, owing to the fact 
that the teeth have crowded the alveolar process upon the outer 
surface of the bone, thus forming a large arch. The only 
irregularity of the teeth is on the right side, where the lateral 
incisor, by erupting slightly within the arch, has pushed the 
distal surface of the central incisor slightly outward. 

Case XIV, Fig. 121:.— Mr. M. C, aged thirty-nine years; 
nationality, Canadian. Height of vault, .71 of an inch. 



Ill I III \l». I \i I . IAW.S \\ h I I I I II 



71 



Had always breathed through the mouth until he oame to 
Chicago in L884, since which time he has gradually improved, 
and can now breathe partially well. He has always suff 

from catarrh, and now, when a < , <>l»l is taken, tin* mucous 




Pig. 128. 




Pig. 124. 

membrane of the nose becomes inflamed and mouth-breath- 
ing is the result. 

This case illustrates a marked arrest of development 
of the jaw; on account of the >mall size of the jaw, the 



372 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



teeth anterior to the molars pushed forward and became 
crowded when the molars erupted. Upon the left side the 
second bicuspid has been removed, thus affording sufficient 
room for the eruption of the second molar on that side. 

Case XV, Fig. 125. — Miss C, aged eight years; nation- 
ality. Canadian. Height of vault, .43 of an inch. Has 
always been a mouth-breather. Has suffered from catarrh 
for the past five years. Her general health has improved 
since her removal to Chicago, six months ago. This cut 
shows a marked arrest of development of the superior maxilla. 

This case is illustrated at this age, eight years, as being of 




Fig. 125. 



unusual interest in connection with the theories advanced in 
this work. The usually low elevation of the vault is due to 
lack of development; no doubt the normal height will be 
reached at the proper age. I extracted the temporary molars 
and cuspids upon the left side, and the temporary second 
molar upon the right side, just before securing the model. 
Although the permanent bicuspids and cuspids upon the left 
side are not visible, yet the appearance of the alveolar pro- 
cess leads me to believe that their position will be normal. 
Upon the right side all the teeth belong to the permanent set 
excepting the cuspid. The cause and manner of the produc- 
tion of the saddle-shaped arch upon this side of the jaw is 
nicely illustrated in the position assumed by the second 



I Ml II I \|i. I M I . I \\V - \M> III 111 






bioii8pid and first permanent molar. I * j >< »n removing the 
temporary molar, the crown of the bicuspid was observed t<» 
be situated exactly in the position represented in tin- illustra- 
tion. The first permanent molar, having moved forward, 
has crowded the cuspid into the roof of the mouth. The V 
shaped appearance of the incisors is due to lack of room in 
the jaw for their normal eruption. 

Ca8i XVI, Fig. L26.- Mi- J., aged thirteen yen-: 
Hebrew; born in America. Height of vault, .59 of an inch. 
Adenoid growth in post nasal space. She is unable to breathe 
through the nose 

This i- a case of unusual interest; the arrest of develop- 




Fig. 126. 



nicnt is very marked, and the maxilla is unusually small. 

The lateral incisors have never erupted, and the cuspids have 
moved forward and taken their place-. The jaw is very nar- 
row aero-- at the bicuspids, and much contracted anterior to 
them. 'Idle jaw is of a marked Y-shape. 

CASE W II. Fig. 1-7. -M. L.. aged thirteen year-: 
nationality. American. Height oi vault. .62 of an inch. He 
has breathed through the mouth tor the past Bis year-. 
There is considerable arrest of development of the bones of 
the nose. The left nostril ha- collapsed, and the right nostril 
partially. BO that the patient can breathe through that side 
only, and with difficulty. 

As will be observed, the jaw in this case is well developed. 



374 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



The forward movement of the incisors is due entirely to a 
local cause, that of irritation, produced by the lower teeth 
striking against the roof of the mouth, which caused a deposit 
of bone-cells at that point. 











Fig. 127 







Fig. 128. 

Case XVIII, Fig. 128.— Geo. W., aged fourteen years; 
nationality, American. Height of vault, .59 of an inch. Has 
always breathed through the mouth. The septum nasi is 
deflected; there is a hypertrophy of the mucous membrane, 
and the left nostril is closed. 



I II I II I \1>. I \< I . .1 \\\ - \\ I ' 1 1 I I II 






In this case the ja* is well developed, and although the 

teeth are large there is do marked deformity. The oentral 

incision overlap slightly; the anterior teeth protrude on 

int t » t the pushing forward of the posterior teeth. \ 

side view bdowb this forward Inclination of all the teeth. 

Case MX. Pig. 129, W. T. O., aged twenty-five years; 
nationality, American. Height of vault, .62 of an inch. He 
has been a mouth breather for twelve years. The left nostril 
la entirely closed, the result of a blow received at tl'*' age of 
thirteen. 

In this case the jaw is well developed. The slight saddle- 




Pig. 129. 

shaped appearance of the right Bide is due to the position of 
the second bicuspid and first molar. The second molar has 
crowded the first molar forward and inward. On the left 
side the first molar has been removed and the second molar 
has moved forward, partially filling the Bpai 

Case XX. Fig. L30. — M. II.. aged sixteen years; nation- 
ality, American. Height of vault, .59 of an inch. Has 
always been a month breather. There is present a complete 
collapse of the nostrils. 

This case represents a -mall jaw anterior to the cuspids. 
There is a slight protrusion of the anterior teeth and alveolar 



376 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



process. On the left side the lateral incisor has erupted 
slightly inward relatively to the central incisor and cuspid. 
The two sides are markedly asymmetrical; the left side is 
quite undeveloped. 




Fig. 130. 




Fig. 131. 



Case]XXI, Fig. 131.— Miss H. T. 



aged 



nation- 



ality, . Height of vault. .62 of an inch. Has always 

been a mouth-breather because of the thickening of the muc- 
ous membrane of the nose. 



I III l!KAI>, FACK, JAM 



\M> I I I I li 






In tin- oase the development of the maxilla baa been 
arrested. There is considerable protrusion of the anterior 
teeth and alveolar process, due to lack oi room; ai 
with tin- i- King's disease. Tin* jum is narrow and comprei 
in the region of the bicuspids. On the right Bide the first 
bicuspid has been removed to afford room for the other teeth. 
The left lateral incisor is small and the left bicuspids are sit 
uated within the arch, erupting in this position because 
the retention of the temporary teeth. This Bide approxi- 
mates the saddle-shaped deformity . 

Casi XXII, Fig. 132. J. G., aged sixteen years; nation 




Kg. 132. 



ality, American. Height of vault. .50 of an inch. He has 
been a mouth-breather for ten year-. The anterior part of 
the jaw is contracted, approximating the V-shaped deformity. 
There is no irregularity of the teeth. 

Case XXIII. Fig. 133.— Mr. G. C. A., aged twenty-six 
year-: nationality. American. Height of vault, .75 of an 
inch. Has always breathed through the mouth. 

This case illustrates the lack of harmony between the size 
of the jaw and the teeth, in consequence of which the anterior 
teeth have erupted irregularly. The central incisors overlap 
slightly; the approximal surfaces of the lateral incisors are 



378 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



internal to the palatine surfaces of the centrals. Posterior to 
the cuspids the dental arch is normal. 

Case XXIV, Fig. 134.— Miss E. B., aged twelve years; 
nationality, American. Height of vault, .53 of an inch. Has 




Fig. 133. 




mm" 



Fig. 134. 

always breathed through the mouth. Septum nasi is deflected, 
and the left nostril is closed. The anterior part of the jaw is 
contracted, and in consequence of this contraction the cen- 
tral incisors protrude. The lateral incisors are slightly inter- 



I iir ill \i>. I \< i . JAW8 \M» i i i I II 

nal to the centrals, lack of room in tin* jaw preventing them 
from assu m ing the ir normal position. It will be noticed thai 
the ouspids are erupting. On the left side the second tern 
porarj molar ia seen. 

With this presentation of a very considerable number of 
recorded observations, accompanied bymanj representative 
Illustrations, the writer respectfully submits that his conclu- 
sions must be deemed to be fairly founded on facts, a refu- 
tation of which will require the citation of a like aeries of 
actual observations on the part of anj objector to the eiewa 
herein Be1 forth. 

Di:\ ELI »i'Mi.\ I i >F l in \ \l LT. 

With a view of studying the true conditions of the vault. 
I have conducted a aeries of examinations with the following 
results: 

I procured thirty-six impressions of the mouths of chil- 
dren, ranging from six to twelve year- (see Plate- 1 to 6), for 
the purpose of Bhowing the development These impressions 
were taken in modeling compound as the children came to 
me; therefore were not selected as regards conditions of the 
mouth. Two seta of models were prepared, one for the 
lithographer, aud the other for my own use. A sufficient 
amount i^' compound was used SO that the surplus would 
extend backward and downward in order that the contour of 
the Boft palate could also be secured. This was accomplished 
by the patients placing the tongue against the compound and 
breathing through the nose. Measurements were first taken 

of the model-, and then they were -awed at the median line. 
One half was placed upon paper and an outline taken, then 
the halves were glued together and the saw passed through 
the model transversely, jusl anterior to the first permanent 
molar, then the anterior part was outlined, thus, in this 
manner, the drawings were taken accurately. I am well 
aware that lithograph plates do not give as accurate an illus- 
tration of B model as we would like to have, hut they are 
sufficiently accurate for tin- purpose for which they were 
intended, viz: to show the relation of the teeth to the jaw at 



380 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the period indicated on each plate. These, together with the 
antero-posterior (Plates 7, 9, 11, 13, 15, 17), and lateral 
drawings (Plates 8, 10, 12, 14, 16, 18), give a very good idea 
of the progress of development from the development of the 
first permanent molar through the period of shedding the 
temporary teeth and their places filled with the second set. 

I commenced my series of illustrations at the sixth year 
because it is a well-known fact that deformities of the jaws 
are rarely, if ever, observed before that period. I have 
demonstrated several times in different ways that the changes 
which do take place in the jaws and vault are observed 
between the ages of six and twelve years, depending upon the 
time of the eruption of the permanent teeth anterior to the 
first permanent molars. I secured only three models at six 
years and three at seven years, because the changes in the 
vault are so slight that it would be useless to occupy the 
space. 

There are, however, certain conditions in the contour of 
the vault which must not be lost sight of, and which can be 
studied in these models as easily as though we possessed a 
large number. In a general way the vaults are quite low 
and without character. 

Starting at the median line of the cross sections (Plates 8, 
10, 12, 14, 16, 18), the vault is quite narrow at the upper por- 
tion, and the lines in either direction diverge until the teeth 
are reached. The teeth also diverge outward. Very few of 
the models contain bicuspid teeth until the eleventh year. 

The alveolar process is quite thick in the sixth and seventh 
year-models, but lengthens and becomes thinner as age 
advances. The thickness is due to the fact that the antrum 
is located between the inner and outer plate of bone, and the 
alveolar process not only contains the roots of the temporary 
teeth, but also the crowns of the permanent teeth as well. 

The height of the vault is very low, and while there is not 
always a gradual advance from year to year, yet, taken as a 
whole, from the sixth to the twelfth year there is quite a 
little advance in its height. The normal height of vault is 
not reached until all the permanent teeth are in place, which 



i 111 HEAD, i \« i . i w\ - w i» lit lit 881 

would be after the twelfth year. With but fen exceptions, 
it i line should be dropped from tin* center ot the arch, the 
two lateral halves would be nearl y alike. A slight ridge al 
tln> top ot' the vault is noticed extending along the median 

line in 1'; . ,; . 8, :». 12, 16, 24, 25, 80, 33, 34 and 36. I 

have seen a much more prominent ridge in the mouths of 
children al the ageof two'years, as will be seen in Plate \ 
(Jpon either side of the ridge there is an apparent groove, 
sometimes Blight, and again quite marked, extending fre- 
quently only a Bhori distance, then again quite an extent, and 
sometimes the full length of the suture. It is not always in 
the same location, sometimes in the alveolar process behind 
the incisors, again at the center and often at the posterior 
part of the vault: however, it is more frequently observed in 
the anterior part of the vault than in the posterior, and some 
time- more marked upon one side than upon the other, and 
again only upon one Bide. In Figs. 3, 6, 12 and 19, Plate- I, 
2, 4. the first permanent molars have been extracted. 

In the models of the eleventh and twelfth year-, the second 
bicuspid- are coming down into place, although many of the 
temporary teeth are -till in the jaw. Unlike the temporary 
molar-, these teeth come down vertically, and although they 
have not fully erupted, yet we can see quite a change taking 
place in the length and width of the alveolar process and more 
character in both the antero-posterior and lateral curv< s. 

[n the anteroposterior section (Plates 7, 9, 11. 13, 1.'.. 17> 
the following changes are noticed: In Fig. 1 the temporary 
incisors are decayed down to the gums; in Figs. 5, ,; . 7. Band 
11 the permanent central incisors are just making their 
appearance, while in other- they are about half way through 
or are fully developed. 

Ju>t hack of the incisors a thickening ^\' the alveolar 
process is noticed; in some it is quite thick, and in other- 
thin. This I believe to be due to the relation (^' the tem- 
porary incisors to the permanent one-. If the temporary 
tooth remains in the jaw until the permanent one comes 
nearly through, the alveolar process will be much thicker 
than it would be if the temporary tooth was removed earlier. 



382 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

It is also the foundation upon which the long, thin alveolar 
process builds when the permanent teeth are in place. By 
following the line backward, we find very little character to 
the curves, but as the child grows older the evolution of 
development becomes mere pronounced. The deviation in 
the curves result in a variation of ossification of the suture. 
Sometimes the ossification is uniform throughout, in which 
case the line will be uniform and graceful, as observed in 
Figs. 1, 2, 3, 7, 9, 10, 11, 15, 16, 17 and 21. If the ossifica- 
tion is irregular, then the lines will become wavy and irregu- 
lar, as in Figs. 4, 5, 6, 8, 12, 13, 14, IS, 19 and 20. 

The soft palate is very accurately illustrated in all of these 
drawings, and therefore shows its relation to the hard palate. 
It will be seen that the older the patient grows the longer the 
antero -posterior line becomes. This, of course, can naturally 
be expected, because the development of the jaw is in a pos- 
terior direction. The shape and inclination of the soft palate 
seem to depend upon the distance between the posterior sur- 
face of the hard palate and the forces. 

In examining the models in Plate 1, at six and seven years, 
the six-year molars are in place, and all the temporary ones 
(except in Figs. 3 and 6, where the temporary incisors have all 
been removed) ; in Fig. 6 the left central is coming into posi- 
tion. As far as the contour of the teeth is concerned, it is in 
a normal condition. 

Plate 2, at eight years, the first permanent molars and 
central incisors have erupted in all the figures except in 
Fig. 12, where the first permanent molars have been extracted; 
none of the other permanent teeth have yet made their appear- 
ance. In this plate we observe the change that takes place in 
the shape of the vault. The V arch is beginning to develop 
in Figs. 7 and 9, and the semi-saddle in Fig. 11; in Figs. 8 
and 19 local irregularities of the teeth are observed. 

Plate 3, at nine years, the deformities of the jaws are still 
more marked. In Fig. 13 a semi-saddle is nicely outlined; in 
Figs. 14, 15 and 16 a V-shaped arch us noticed, while in Figs. 
17 and 18 the permanent teeth are not far enough advanced 
to tell what position they will occupy. 



i 111 BEAD, i \« i . JAWS \M> i i i i ii 

Plate i. at ten 3 ears, the teeth are a little further advanced 

th.-m at nine years. The bicuspids are just pushing their 
through and the jaw seems t<> be taking on character. Fig. L9 
shows the central incisors crowding their wa} to the 1 
Bide, producing a marked deformity of the jaw. Fig. 20 also 
shows the incisors crowding to the right and the lefl cuspid 
just coming through the gums, producing a semi V shaped 
arch. Fig. 21 illustrates all the temporary teeth Bhed and 
the bicuspids first coming through; the permanent teeth are 
not far enough advanced to decide just what kind of a deform 
itv will be produced; from the lapping of the central incisors, 
and the fact that both bicuspids are erupting before the 
cuspids, it is safe to say that a V shaped arch will be pro 
duced. The permanent teeth in Figs. 22, 23 and 24 are not 
far enough along to judge what the results will be. 

Plate 5, at eleven years, the deformities are -till more 
easily traced. Fig. 25 shows a local irregularity — a crowd 
inir inwards of the right central incisors— due to want of 
room, produced by the forward movement of all the teeth on 
the right Bide. The V and -addle arches are nicely illustrated 
in Figs. 28, 29 and .".<». Fig. 28 show- arrest of development 
of the maxillary hone-, and a marked V arch will result 
This model illustrates the upper jaw of a hoy. seventeen years 
of age; his body became arrested in it< development at about 
nine years of age, caused by some of the eruptive fevers. 

Plate ♦',. at twelve year-, the temporary teeth art- y.i 

noticeable in many of these illustrations. It is easy, how- 
ever, to outline the forms of irregularities that will he pro 
duced when all the permanent teeth are in place. 

We have now fixed the date and the character of the 
deformity of the vault, that will he produced when all the 
permanent teeth are in plate, namely, between the -ixth and 
twelfth year, or at the time of the development of the per- 
manent teeth, and the deformity of the vault will depend 
upon the manner in which the teeth came into the jaw and 
will he a V or saddle-shaped arch with their modifications, 
partial V or saddle. semi-V or -addle. 

The shape of the vault i- also changed by local irregular- 



384 ETIOLOGY OF OSSEOUS DEFORMITIES OF 



Deformed Vqulte. 




Fig. 1:55. 



I III III \l\ FACE, JAWS \M» I I I 1 II 

of the teeth. In such oases any of the teeth maj - and 
inside or outside the dental arch and the vault will conform 
to the deformity , 

mi OBMl n "i Mir-iii 1:1 . 

We have Bhown thai the deformity of tin- vault is not 
observed until at or about the sixth year, or the time of the 
eruption (>t" the permanent teeth. The ossification of the 
suture, uniting the maxillary hour- at the (median line, how- 
ever, takes place at different intervals -sometimes as early as 

the eighth week of inter-uterine life, and as late a- the >i.\ 

teenth. I have frequently demonstrated this in my treatment 

<^ the deformities of the jaw. 

I have observed the formation of the excessive develop- 
ment of the suture as early as the second year and as late 
as the thirty-sixth year. This excessive development takes 
different shapes and forms; thus, in 228 Peruvian >kulls. 
240 Stone Grave bkuIIs and twenty-one Mound Builders 1 
skull-, sixteen Peruvians, thirty-nine Stone Grave, and one 
Mound Builder's (all of which had large, well-developed 
jaw-, normal in shape) possessed a rope-like projection 
extending the entire length of the suture. This develop- 
ment appeared unlike the excessive development as noticed 
in modern skulls. It had the appearance of having been first 
made and then glued upon the suture as observed in Fig. L35, 
No. 1. 

The deformity of the suture in No-. 2, 3, I, ~> and •'•, 
varies in proportion to the width of the arch (in the narrow 
arch the suture is <juite low. or thick, while in the normal 
arch they are quite fiat; the grooves of either Bide of the 
suture are not uniform, one side being deeper than the other. 
It 'is claimed by scientific men that these grooves are due 
to ossification of the vomer, which would produce rigidity of 
the suture, and the hone upon either side is afterward carried 
up. Thu>. Clouston -m\ s: 

"Those palates, where the deformity consisted in a ridge 
down the center antero-posteriorly, seemed to -how that in 

* Dental Recon I. May, 1891, p. 200 



386 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

PLATE A 




111! Ill \h. I \< I . i kW8 \M> I I I I II 

thrin the deformity took place at a later i >« • i i* »» i than in the 
other deformed paint*--. When the nasal leptam wta getting 
stronger and kept tin- oenter of the palate «1« ►%% n, srhili 
eaohaideofil the palate was drawn up. making two vaults 
side by side, instead of one." Plate A, six models are shown, 
ranging from two to sis years. Fig, I. at two years, -h<>w- 
a ridge extending from a line drawn across the vault at the 
cuspids, through the entire length of the jaw. Fig. 2, at two 
years, shows a similar condition of tin- ridges, except that it 
begins in the center of the vault at a line drawn across the 

first temporary molar. Fig. ."'., at three year- ofage, Shows 

a slight ridge just hack of the incisors, extending only a 
short distance, when the center of the vault i- perfectly flat, 
and the ridge begins again in the posterior part of the vault. 
Fig. 4, at four years, Bhows the ridge starting at a line drawn 

across the vault at the first molar and extending the entire 
length of the suture. Fig. 5, at five years, shows a broad 

ridge extending the entire length of the vault. Fig. 6, at 
BIX years, shows a very narrow ridge, also extending the 
entire length of the vault. 

As the vault ossifies as early as the first or second year, 

and as the ridge is also found as early as the second year, the 
vomer not ossifying until later in life, the theory will not 
hold good. The ridge takes so many different shapes that, 
when a number of models containing it are examined, the 
theory that the Bides of the arch are drawn or pushed up, 
seems absurd. Thus, models Figs. 7 and S, Plate B, show 
vaults similar to No. 2, Fig. 135, except the grooves are deep 
and -harp. Fig. 7 extends from jusl back of the incisors to 
opposite the second molar- where the arch becomes perfectly 
smooth throughout the balance of the hard palate; Fig. v 
commences at same point and -top- opposite the first perma- 
nent molar. These models alone -how the fallacy of this 
theory because nothing could force the deep groove- in the 

*The author has a number of these models showing the ridge at the second 
year, and he has observed many more in his practice. Since the fcwo ha] 

the maxillary bones are supposed to ossify at the eighth week of fatal life, it 
can be readily seen that in those cases where ossification was not complete 
these ridges would form when the child begins to masticate its food. 



388 ETIOLOGY OF OSSEOUS DEFORMITIES OF 



PLATE B 




IBB HEAD, FACE, JAWS AND TEETH 

anterior alveolar process, us su (jested i>\ many authors, linoe 
the vomer extends through and beyond the anterior iuri 
of the anterior alveolar process to form the nasal spine. It 
Bueh a thing were possible, the posterior part <>t" the vaults, 
which would easily yield to force, would be affected, which is 
not the case. The ridge extends to the second molar, or as 
Ear as the grooves. One of the jaws is very* small and con- 
tracted with Blight hypertrophy extending all around the 
inner surface, giving the sharp appearance to the grooves; 
the other is a little larger, has no hypertrophy, hence the 

groove upon either side of the suture i- not 80 narrow, 
although fully as deep. Figs. !» and 10, Plate (\ -hmv well 
developed jaws with very broad ridge-. In Fig. 9 the ridge 

commences about opposite the firsi bicuspid and extends hack 

as far as the second molar tooth; in Fig. 10 the ridge extends 
from the alveolar process just hack of the incisor, to the sec- 
ond molar; both are about the same width. The grooves 
upon either side are very shallow and about the same depth 
of ridge. These are similar to No-. 1, .". and 6, Fig. L35. 
Fig. 11, Plate D, is a very small jaw with a marked ri< Ilto 
commencing in the alveolar process, back of the incisors, and 
extending as far as the second molars; the groove- upon 
either Bide are very deep and sharp. This is due to a -mall 
jaw and hypertrophy of the alveolar process. We occa- 
sionally find a groove in the center of the vault running 
the entire length of the suture in place of the ridge, as 
illustrated in Fig. 1l\ Plate D; this is due to two causes: (1) 
Arrest of development of the suture, and, | '1 > hypertrophy of 
the palate bones and mucous membrane upon either Bide of 
the suture. This groove is sometime- -hallow, again deeper, 
sometimes broad, and again narrower— depending upon the 
extent of the hypertrophy. 

The two sides of the contracted arches are not uniform. 
This is due to the location of the teeth in the alveolar process 
which are in more upon one side than upon the other, carry- 
ing the alveolar process with it. The sides of the palate are 
not carried up, because there is no force to move them. 
Sometimes these dee}) grooves are situated entirely in the 



390 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

PLATE C 




I ill ill \i>. PACK, JAWS \m> i i i i ii 

anterior alveolar process; sometimes entirely on one tide; 
sometimes in the center of the vault in the anteroposterior 

direction, and again in the posterior pari oi the vault. 

The location n\ these grooves, especially 1 1 n •-«• in the 
alveolar process, and tin- t'a.t that sometimes th«\ extend 

onlv .25 to ..*)i» of an inch, wmilil preclude BUCh a theory. If 

the Bides were carried uj», owing to the \r\y thin bone, a like 

projection would extend into the floor of the DOSS. I have 

examined 1,367 skulls with this deformity, and I have yet to 
find the first Instance. In everj case the floor of the nose 

and commencement oi the septum were smooth and evenly 

developed throughout its entire length. How. then, arc 
these deformities to be accounted fori We have seen that 
these projections are developed a- early as the second year. 
and as late a- the t hirty--ixt h year. We are Safe in the 
assurance, that they are the result of excessive development 
of the suture, due to irritation set up at the time of ossifica- 
tion, by mastication the lower jaw developing laterally 
foster than the upper, thus crowding the superior maxillary 
bones apart. I have observed this action in a large number 
of my patients, one of which I will here describe. 

A lady, thirty-six years of age, who has la-en under my care 
for the past fifteen years, ha- a space between the central 
incisor- of .50 of an inch. Xo -pace was observed until -lie 
arrived at the age of twenty years. The teeth tilled the arch 
and all antagonized. The lower jaw continued to develop, 
and the act of mastication carried the superior maxillary bone 
laterally — widening the suture, the -pace tilling in and pro- 
ducing quite a ridge, as noticed in Fig. 135, No's. 1. 5 and »'■. 
The depth ot the ridge depends upon the amount of irrita- 
tion. The height of the groove upon either side to the depth 
of the ridge. When there are grooves upon either side the 
jaw is always contracted — the alveolar piece-- being nearer 
the center of the vault. This, together with the ridges, pro- 
duces the groove. If it were not for the excessive develop- 
ment of the median suture and contracted arch the vault 
would take the shape of the dotted lines and would be nor- 
mal in its development. 



392 



ETIOLOGY OF OS8EOU8 DEFORMITIES OF 



PLATE D 




I ill iii\i>, PACE, JAWS \m> i i i i II 
i»i i . iRMl D VAULTS 

Deformed \ : i u 1 1 - are due (1) to to irregularity in the 
arrangement oi the dental arch, (2) hypertrophy of tin' alve 
olar process and maxillary bones, and S toexoeeaiye devel 
opment oi the palatine suture, [irregularities oi the dental 
arch are the result oi two causes: i Neuroses oi develop 
ment, producing arrest oi development oi the maxillary bone; 
(2) local causes, or the re-nit oi accident. Those produced 
by an arrest of development take typical forms, which I have 
classified by taking 8,000 models oi irregularities of the teeth 
and grouping them under the heads oi V, partial V. semi-V, 
saddle, partial saddle and semi-saddle. The irregularis 
tin- teeth produced by local causes do cot take typical form-. 
but are as numerous as the number of cases. 

Hypertrophy of the alveolar process may affect the whole 
dental arch, or it may attack one particular locality in which 
only one, two or three teeth may he involved. The shape of 
the vault in such cases depends entirely upon the extent of 
the hypertrophy, but does not take the typical form. The pos- 
ition, occupied by the teeth in the dental arch, and the man- 
ner <>f their formation are Btudied under their respective 
heads. Having then found the true cause of the deformed 
vault, let us examine some of them and see how they com- 
pare with the normal vault. I secured an entirely new set of 
models from dental practitioners in Chicago, consisting of 
six Y-shaped (Plates 35 and 36), six semi-V (Plates 37 and 3^ . 
six -addle t Plates 39 and 40), and sis semi-saddle-shaped 
(Plates 41 and 42). These were prepared in the same manner 
as the other model-. 

The direction of the teeth in a normal jaw are nearly per- 
pendicular, while those in the V-shaped vault are at an angle 
of 45°. This, of course, is owing to the forward movement 
of the incisor teeth. Ju>t back of the incisor teeth there is 
quite a prominent ridge of alveolar process noticed in the 
drawings of the normal jaw. which is due to the contraction 
of the vault in the anterior portion, producing a thickening 
of the alveolar process. In other respects the vault doe- not 



394 ETIOLOGY OF OSSEOU8 DEFORMITIES 

differ from the normal palates. The same general rule holds 
good in the semi-V vault, except the teeth do not stand at 
such an angle. This is accounted for by the fact that fre- 
quently only one incisor protrudes, therefore only one incisor 
extends: while the other is in a perpendicular position. The 
position of the normal tooth may have been on the side of the 
model reproduced in this drawing. In the drawings, show- 
ing a cross section of the vault, it w T ill be noticed in a general 
way that the vaults are much narrower than in the normal; 
it will also be noticed that the two sides of the vault are not 
in harmony. These drawings are all very accurately made, 
so that by placing a rule at the center of the upper and lower 
arches and drawing a line from one to the other, the two 
sides of the vault can be easily studied. The more contracted 
the jaw the higher the vault seems to be, and the sides seem 
to be more irregular. In the saddle and semi-saddle antero- 
posterior drawings the teeth stand perpendicularly, there- 
fore do not protrude. The ridge, posterior to the incisors, is 
not so thick or prominent. The lateral drawings do not show 
the pinched condition at the upper part of the vault that is 
noticed in the Y-shaped vaults. This is due to the fact that 
the contracting is not in the anterior part of the mouth, but 
at the bicuspid region, while the bicuspids are carried in. 
The top of the vault is rarely ever affected. Occasionally 
hypertrophy of the alveolar process is so extensive that the 
teeth are carried laterally toward the median line, the vault 
is very much narrower, and in some cases it is almost closed. 
It will also be observed that the figures do not correspond with 
each class of deformities. 

DEFORMED VAULTS DUE TO LOCAL IRREGULARITIES OF THE 

TEETH. 

Such irregularities of the teeth can only affect the margins 
of the vaults, and not the vault proper, as only a few teeth 
are involved. The remainder of the dental arch, being as a 
rule in a normal condition, the vault proper is retained in its 
natural shape. 



CHAPTER XXXI. 

I LEFT PALATE 

Clefl palate iras much discussed bj early writers. Early 
in the nineteenth century Tiedemann noticed that in oer- 
tain oases of clefl palate the olfactory nerve was absent or 
abnormal. H<- concluded therefrom that the deformity was 
resultant npon atrophy of the olfactory organ of nervous 
origin. This theory, however, failed to meet much accept- 
ance. M- •'• Weber, after a careful analysis of all accessible 

Oases, failed to find one in which the olfactory nervr was 
absent In all probability the coincidence of cleft palate and 
olfactory nerve atrophy discovered by Tiedeinann resulted 
from the sime central nervous maldevelopment. and they 
bore no causal relation to each other. 

The etiology of cleft palate is necessarily involved in 
Obscurity, since cleft palates are comparatively rare, in pro- 
portion to other forms of nutritive degeneracy, and Brace 
they occur so early iu foetal life. Palatal embryology, to a 
certain extent, casts light on the aetiology. f At a very early 
period of foetal life a series of clefts appear on each side of 
the cephalic extremity, separated by rod- of tissue called 
branchial arches. The clefts communicate with the alimen- 
tary canal. These various clefts have usually coalesced about 
the ninth and tenth week of total life, but occasionally this 
coalescence fails or is incomplete. This leads to various 
deformities, the chief of which are .left palate and harelip. 
After an analysis of these embryologies] fat-tor-, that able 
teratologist Bland Sutton, A r state- that "cleft palate has been 
known to affect several members of the same family and to 
occur in the offspring of the affected members." He cite- 
instances of the transmission ofthia deformity from an affected 
pug-bitch to her offspring. He states further, "if it were 



•Zeitechrift f. Phys.. Band 1, Heft 1,1814, p. TL 

n'a American System of Surgery, p. I 
| Evolution and Disease, p. 189. 






396 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

possible to practice selective breeding in man as in dogs, 
a race of men with harelips and cleft palates could be 
produced." 

Engle refers cleft palate to excessive development of the 
anterior portion of the brain and skull, such as produces 
hernia cerebri, ventricular atrophy or excessive anterior cer- 
ebral lobe development. This mixed patho-teratological theory 
is not warranted by either embryology or clinical observation. 
The narrow and broad foreheads are alike affected. 

Langdon Down has found a constant relation between 
brain deformity, cleft palate, and deformed vaults. Down 
states that: " The cause of the frequent excessive vaulting of 
the palate is not quite clear. It may possibly arise, as has 
been suggested, from sphenoid arrest of development or 
vomer defects in development." It has been plausibly shown 
that the contracted high vault is not due to these conditions, 
and that there can be no relation between contracted vaults 
and cleft palates. The cleft occurs before the tenth week of 
foetal life, while the contracted vault does not appear until 
after the sixth year. The claim is made by Walther* and 
Langenbuchf that cleft palate was becoming more frequent 
during the present century. This opinion was supported by 
Oakley Coles, % on the ground that palatal vault deformities 
were more frequent, and that a relationship existed between 
these and cleft palate. He further states that "we shall be 
led to the inevitable conclusion that the relation between a 
high state of civilization and a high proportion of palatal 
deformities is something more than a mere matter of coinci- 
dence." ' 

In the study of this subject, however, an assumed relation- 
ship between palatal deformities and cleft palate may, for 
reasons elsewhere given, be at once dismissed from con- 
sideration. 

Early literature on this subject is admittedly meagre. 
The early teratologists discussed the gross rather than the 

*Graefe and Walther's Zeitschrift. Band 21, Heft 2, 1834, p. 175. 
t Neue Bibliothek f. die Chir., Band 4, Heft 3, p. 492. . 
% Coles: Deformities of the Mouth. 



I III III \l'. I \< I . I \W - \M» I I I I II 

minute details, and the registration <>i' cleft palates nrai 
neglected in common \w\\\ brain, renal, hepatic, and cardiac 
teratology 

Cleft palate maj be divided into two classes congenital 
and acquired* Bj congenital is meant existing afl birth; 
acquired cleft palate is the result of disease, inherited or 
acquired, but affecting the part after birth. It is not intended 
here t«> discuss this subject, except to indicate that better 
acquaintance with etiology of disease, and its effects upon the 
hard palate, will -how causes of congenital lesions and effi 
of acquired disease upon the tissues to be at least allied. 

Congenita] cleft palate is divisible into two kinds 
complete and partial: complete when the fissure extends th<- 
entire length from the uvula to and including the anterior 

alveolar process, and even the lips; partial when only a small 
part of the structure is involved. Thus the cleft may extend 
through the anterior alveolar process, involving only the inci- 
sive bones, which is very rare: when present, single or double 
harelip almost invariably co-exists. 1 have observed in prac- 
tice six cases where a small portion of the anterior alveolar 
process and jaw w r as involved, with one or two teeth. The 
hard palate only may be involved to the extent of a small 
fissure, or the whole palate maybe wanting. The soft palate 
only may contain the cleft or simply the uvula. Cases are 
on record in which the non-development of the intermaxillary 
bones produces fissures in the lip. A priori cleft palate would 
seem to be an expression irf hereditary defect. This view is 
that taken by Bland Sutton- from actual observation. Oakley 
Colest states that "the antecedent which strikes one aprwriy 
as being likely to play the most important part in the pro- 
duction of congenital deformities, i» that of hereditary influ- 
ence. But though it will he evident from the fact- which I 
-hall presently adduce that the indirect influence of heredity 
in the production of cleft palate is marked and undeniable, 
no sufficient statistics have a- yet been brought forward to 
-how that the actual presence of the deformity in the parent 

olution and Din 
t Deformities of the Mouth. 



398 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

has any direct predisposing influence on its occurrence in the 
child. In other words, though the defective conditions which 
precede and accompany the phenomenon of cleft palate are 
almost certainly to be referred to parental influence, it is 
extremely doubtful whether cleft palate is in itself transmis- 
sible. I am fully aware that such distinguished authorities 
as Demarquay, Roux, Trelat, Follin and Duplay are inclined 
to an opposite belief, and their conclusion is supported by the 
evidence in connection with the analogous deformity of hare- 
lip. Still, unless accurate records of ancestry could be 
obtained for three or four degrees of removal, it would be 
premature to make any positive assertion on the point. I 
feel, however, that it may be confidently stated that the 
deformity cannot be produced from any impression received 
by the mother during pregnane}'. In most of the cases 
which have come immediately under my notice, where one of 
the parents had a cleft palate, all the children born have been 
perfectly developed, even though dread of transmitting the 
deformity was always present in the mind of the mother. 

"In one case, curiously enough, there are three members 
of one family with cleft palate, one seventeen years of age, 
the other thirty, and the third thirty-five; the first and last 
are ladies, the other a gentleman who is married and has a 
family without any trace of the father's deformity. In these 
cases no instance of cleft palate could be found either among 
the ancestors or the collateral branches of the family; but it 
will be interesting to watch whether in the following gener- 
ations any traces spring up again, for cases of immediate 
transmission seem but rarely to have been placed on record. 

" In the case of another family, however, I have obtained 
the following remarkable history: 

"G. H. C, born 1853; perfect. L. C, born 1855; single 
harelip and cleft palate. J. F. C, born 1856; perfect. F. 
W. C, born 1860; double harelip and cleft palate. H. E. C, 
born 1863; perfect. The paternal grandmother also had cleft 
palate." 

My own observations, so far as they go, only justify me 
in taking the tentative position of Coles. 



i in HEAD, FACE, JAWS AKD TEETH 

Kn.vht found five per cent of 1,200 criminals exao 
to have oleft palates, and fourteen per cent oi id.- prostitates 
examined by Pauline Tarnowskyl had cleft palates. Dr. 
Langdon Down among congenital idiots found onlj ahali per 
cent <>t oleft palates. Grenser only found nine cases in 
14,466 children, or one in 1,607. I examined L,977 feeble 
minded children without finding a single case. In l'"7 blind, 
hut t.nt- case ns:i- observed. In 1,986 deaf mutes two cases, 
or about one in 1,000. The percentage among the defective 
classes ia not large, but undoubtedly it i- much larger than 

anion*: normal individuals. 

Bland Sutton's experiments with dogs, elsewhere 
indicate the presence of this deformity among animal-, and 

further, that it is transmitted. The followers of Wei — mann. 

relying upon bis dictum} that acquired defects are not trans- 
mitted, will dispute the validity of these experiments. \Y 
mann's original position on this subject ha- been abandoned 

by him, for he states, § in his latest work, that "the origin of 
a variation i- equally independent of selection and amphimixis, 
and is due to the con>tant occurrence of slight inequalities of 
nutrition in the germ plasm." The influence of this factor i- 
shown by the statistics of zoological gardens. A keeper of 
the Zoological Gardens in Philadelphia observed cleft palates 
in the mouths of lion cubs horn in the gardens. Cleft pal- 
ate- were also observed in a number of puj»> horn in Buffalo. 

Dr. Ogle found that ninety-nine per cent of the lion cubs 
horn in the London Zoological Gardens had cleft palate-. He 
claim- this isdue to the artificial diet as the result of enforced 
captivity. Similar results observed in other gardens in Europe 
are charged to feeding the mother with meat without hone. 
Feeding with the whole carcass of -mall animal- greatly 
diminishes these deformities. 

It would seem that if cleft palate could be attributed to 
this cause, other bony structures should also be involved. 

* Cited by Lombroso. Criminal Man. 
+ Etudes Anthropometriques. 

X Essays on Heredity. 

* The Germ Plasm. 



400 ETIOLOGY OF OSSEOUS DEFORMITIES 

Many of the lions born in captivity were rickety. Cleft palate 
has been observed among dogs, sheep, goats, etc. The ques- 
tion, therefore, whether domesticity does not play in them 
the alleged part of civilization in man, can be solved only by 
a knowledge of the frequency of the condition among wild 
animals of the same genus. It is evident that in dealing with 
the question of aetiology the influence of shock on the mother's 
nervous system cannot be excluded in the cases charged to 
feeding. 

It may be here of interest to note the date of the develop- 
ment of the parts chronicled by Beaunis and Bouchard: 

u Beginning of third week — first pharyngeal arch; buccal 
depression. End of third week, coalescence of the inferior 
maxillary protuberances; formation of the three last pharyn- 
geal arches. Fourth week — olfactory fossce. Fifth week 
— ossification of lower jaw. Sixth week — the pharyngeal 
clefts disappear; the tongue, the larynx and germs of teeth. 
Seventh week — points of ossification of intermaxillary bone; 
palate and upper jaw (its first four points). Eighth week — 
the two halves of the bony palate unite. Ninth week — 
osseous nuclei of vomer and malar jbone; the union of the 
hard palate is completed. Third month — points of ossifica- 
tion for the sphenoid and nasal bones; squamous portion of 
temporal; orbital center of superior maxillary bone; com- 
mencement of formation of maxillary sinus; epiglottis. Fifth 
month — osseous points of lateral masses of ethmoid; ossifica- 
tion of germs of teeth; appearance of germs of permanent 
teeth.*' 



CHAPTER XXXII. 

NEUROSES OF DEVELOPMENT OF IRREGULARI- 
TIES OF THE TEETH. 

i in \ -ii kPED \i:< ii. 

Irregularities of the teeth and jaws, resulting from exces- 
sive development, have been described. It remains new to 
show !m»\\ irregularities result from arrested development. 

Arrest of development is routined mostly to the upper 
jaw. hence V and saddle-shaped arches are more aumerous 
than irregularities of the lower jaw. Local conditions, such 
as premature extraction of the temporary teeth, causing the 
first permanent molar- to move forward, thus diminishing the 
size of the jaw, are also the cause of these irregularities. 

The manner of these formations is as varied as the peculi- 
arities themselves. 

It may he well :it the outset to state that the only structures 
involved in the formation of these deformities arc the jaws 
and the alveolar process on the one hand, and the teeth upon 
the other. The alveolar process is soft and yielding, while 
tlu 1 teeth and jaws are composed of hard, unyielding BUD- 
stances. The process adapt- itself to the conformation of 
the teeth. We are taught that the teeth of the superior or 
inferior maxilla constitute a dental arch, and that the first 
permanent molar- perform the function of key- to the arch. 
After year- of thorough investigation I find that the jaw- and 
teeth, like the lateral halves of the body, develop independ- 
ently of each other, both possessing their own peculiar char- 
acteristics as regards irregularities of the teeth. In order to 
simplify the classification of irregularities of the teeth I -hall 

call the lateral halve- n\' the jaws which are separated by the 
median line, the right and left inferior and the right and left 
superior dental arches. While these terms as applied to the 

lateral halves of the maxillary hone- are not Btrictly correct 
from an architectural point of view, yet practically (as will 



402 ETIOLOGY OF OS8EOUS DEFORMITIES OF 

be seen) they answer the purpose for which they are employed. 
The manner of the formation of the V-shaped arch and 
kindred deformities may be compared to the construction of 
an arch of stone. The changes which take place in the move- 
ment of the teeth are very similar to those which may occur 
in a stone arch of faulty construction. Figs. 136, 137 and 13S 
represent one normal arch and five varieties of .irregularities 
of the teeth. Each lateral arch is viewed as containing stones 
corresponding in number and size with the teeth of a normal 
upper denture. Fig. 136 represents two arches; the left 
superior arch is perfect. The first stone is marked " posterior 
base/* and corresponds to the first permanent molar. The 
second stone is the "anterior base"; it correponds to the 
central incisor. The next stone is located upon the anterior 
base and corresponds to the lateral incisor. The succeeding 
stones are laid upon the posterior base, and represent the first 
and second bicuspids. The stone corresponding to the first 
bicuspid is usually in position first, but sometimes the stone 
corresponding to the second bicuspid is placed first. To com- 
plete the arch it is necessary to place the "key-stone'' in 
position — the cuspid tooth. If the stones have proper pro- 
portions and the measurements are correct, the key-stone will 
fit into place and the arch will be complete. We shall find 
on examining the foundations, two more stones, which cor- 
respond with the second and third molars; these stones, with 
the base and the stones above the base, making a strong abut- 
ment. 

THE NORMAL ARCH. 

In order that aberrations from the normal may be better 
understood, let us first consider the question, what consti- 
tutes a normal arch. 

There are three characteristics of the normal arch. Inde- 
pendent of temperamental peculiarities, the line extending 
from one cuspid to another should be an arc of a circle, not 
an angle or straight line; the lines from the cuspids to the 
third molar should be straight, curving neither in nor out, 
the sides not approximating parallel lines. Absolute bilateral 



III! Ill \l». I \< I . .1 \\\ - \M» I I I I II 






uniformity is do! implied in tin-, m the tw<> Bidet ol the 

human jaw an- rarely if ever who|l\ alike. A uniform arcfa 

necessitates a uniformity <»t development between the arcfa of 

the maxilla and the arch ol the teeth, and a correct ) >< ~i t i« >n 
of thi> individual teeth in their relation to each other. Winn 
there i- inharmony of development between the jaw and the 

teeth, a- may happen when one parent ha- a -mall maxilla 

with corresponding h -mall teeth, and the other a large one 
with correspondingly large teeth, if the child inherit- the jaw 

of one and the teeth of the other, irregularit ie- niu-t follow. 
Such difference in diameter between the arch of the maxilla 




Big. 136. 

and that of the crown- of the teeth i- a Constitutional cau-e 

of irregularity. 

Whenever there is a difference between these diameters, 

the line formed by the teeth must either fall outside or within 
the arch of the maxilla, and irregularities of arrangement 
result 



FORMATION OF THE V-SHAPED UBCH. 

In Fig. 130 the right superior arch -how- the diameter of 
the stone- to he either too small for the curve of the arch, or 
that the bases were Bet too far apart for the curve of the arch. 
This results in a greater -pace for the key-stone than is 



404 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



required, and not finding support it drops through toward 
the center line. 

In Fig. 137 the right superior arch shows that the poste- 
rior base and the foundation stones have been brought for- 
ward to such an extent that when the other stones are placed 
in position, the space intended for the key-stone is entirely 
closed and the key-stone remains outside the arch. The left 
superior arch appears as though the key-stone were too heavy 
for the arch, and its weight has carried the smaller stones 
with it. The posterior base with its foundation stones, being 




Fig. 137. 

the strongest, resists the force; the anterior base being weak 
and without support, bulges out, and in this way a semi-V- 
shaped arch is produced. 

Fig. 13S illustrates the V-shaped arch. The right supe- 
rior arch shows that the key-stone has gradually carried the 
arch inward; the posterior base is in its proper position, the 
anterior base has been carried forward, and all the stones are 
in line. The key-stone in the left superior arch has produced 
the same result as upon the opposite side, excepting that the 
posterior base and the foundation stones were placed too far 
forward, leaving insufficient space for the key-stone. The 
teeth, however, do not bear the same relation to one another 



111! 1IKM'. I \< I 



\\!» I I I I II 






apoo their approximal surfaces that 1 1 1 * - stones ot tl • 

,1(». The Btones of .in arch have broad, flat surfaces, irhile 

the teeth touch merely upon the points of roanded -mi 

The ten anterior teeth \v 1 1 i <- 1 1 are involTed in the construe 
t ion of the V shaped and kindred irregularities, are Illustrated 
in Fig. L39, in whichihe positions of the roots and crowns, and 
their mutual relations, are approximately Bhown. As will be 
observed, the teeth are all vredge-shaped, tin- bases b< 
lo» sated near the cutting and grinding-edges and the apices at 
the ends of the roots, These are nearly round and conical, 
the points of antagonism being near or quite at the cutting or 




Fig. 138. 

grinding edges. Fi#. 14i» Bhows a section of the teeth at 
their points of contact. These point- must be kept in mind. 

as they constitute the fulcra of the levers, which, when force 
l- applied to the teeth, cause them to rotate and move out of 
position, thus producing a greater variety of deformities than 
it is possible to demonstrate upon the stone arch. 

As has been previously mentioned, these irregularities are 
not observed until after the eruption of the second set of 
teeth. We shall therefore first consider the first permanent 
molars. These teeth are the largest, strongest, and possess 
the largest roots of any of the teeth. They are located pos- 
teriorly to the temporary set Owing to their position and 



406 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



to the fact that they have long, lai:ge roots, their apices are 
directed backward, and, in a majority of cases, the distance 
from the apex of one root to that of another is greater than 
at the neck, which fact indicates that they are firmly fixed in 
their alveoli. The alveolar process is wide at those points; 
these teeth therefore would naturally be designated a,s the 
posterior basis of the lateral arches. 

The next teeth which make their appearance are the cen- 
tral incisors. These are situated in the extreme anterior 




Fig. 139. 




Fig. 140. 



alveolar process on either side of the median line, and the 
process is quite thin at these points. These teeth will be 
called the anterior bases of the lateral arches. The next to 
make their appearance are the lateral incisors, which take 
positions at the distal surfaces of the central incisors. The 
roots of these teeth are not so large nor so long as the roots 
of the centrals; therefore they are not as firmly fixed in the 
alveoli. Each lateral tooth, however, is supported by the 
central, and represents the second stone upon the anterior 
base. The teeth which next appear are the first bicuspids. 






nil HEAD, i \< i , JAWS wi» i i i i ii 

[mmediatelj following are the Bee 1 bicuspids, which repre 

sent the second and third stones upon the posterior ba 
The arches are then complete, except the kej itont the 
ouspid teeth. These cannot be omitted, for thej bind and 
hold the teeth together and give beauty and Bhape to the 
arches, rhe follicles of these teeth are originally situated 
outside of and above the crown and root- of the teeth alreadj 
in the arch, which results in a larger circle; and because these 

teeth have lone;, powerful roots. iinu>ual power and leverage 

is given them. For this reason they are directed downward 

and inward, their crowns being SO located that the lips aS818t 

greatly in aiding the downward movement of these teeth. 
The downward and inward movement of the cuspids is simi- 
lar to the lowering of the key-stone in an arch; it continue- 
to move downward until it meets with an obstruction, which 
may he confined to the upper jaw and include the teeth ante 

rior and posterior to the cuspid. It' the teeth in position are 

in harmony with the jaw, the cuspids will descend into their 
proper places and. touching the teeth on each Bide, lock the 
arches and hold the teeth in proper position. 

Let us examine the arches with their bony encasements, 
and ascertain what the bases arc resting upon, the relative 
strength and support of each base, and the relative strength 
of the anterior and posterior columns. In the posterior parts 
of the mouth the alveolar process is very thick, and the base 
— the first permanent molar— is large, having three roots in 
the upper jaw and two in the lower, curved and BO arranged 
in the alveolar process a- to preclude its going backward. 
We also find other teeth of nearly equal strength posterior to 
the first permanent molars. Anterior to the base — the first 
permanent molar we find the first and second bicuspids: 
these teeth are all firmly imbedded and situated in the long 
axes of the alveolar process, forming together a very linn 
base. The anterior column of the arch consists of but two 
teeth, while the posterior column has five. Tin' anterior teeth 
possess single root-, and are situated crosswise in a very thin 
alveolar process, thus demonstrating the comparative weak- 
ness of the anterior arch. In some instance- the space may 



408 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



be too large in the superior arch, and the key-stone or cuspid 
tooth may continue in its downward course till it engages 
with the the teeth in the lower jaw. 

DESCRIPTION OF THE V-SHAPED ARCH AND ITS MODIFICATIONS. 

The V-shaped arch presents a triangular outline (Fig. 141), 
the apex of the triangle being formed by the central incisors 
where the process is usually bent so that the incisors form an 
angle instead of being in line. From this apex the lateral 
halves are in a straight line terminating at the first molars; a 
line connecting them forms the base of the triangle. The 
cause of this peculiar outline is a want of correspondence 
between the size of the jaw and teeth, or the premature 




Fig. 141. 

extraction of the temporary molar, or both causes combined, 
thus allowing the first permanent molars to move forward. 
When the rest of the permanent teeth come in they do not 
find room and are thus crowded together; the process must 
give way in order to adapt the greater arch formed by the 
crowns of the teeth to the lesser arch of the maxilla. The 
point of fracture is in or near the median line, since the pro- 
cess is thinnest at this point. The illustrations given here 
show varieties of this type. By comparing each one with the 
diagram it will be seen that they all are triangular in outline, 
Fig. 144 being the best representation of this form of irreg- 
ularities. A line passing from the median line of the central 
incisors through the cutting edges and crowns is straight. 



Mil III M-. I \< I . I \N * Wl» I I I 1 II 






The Btudi of the cases here given showi the result oftb< 
ward movement oi the first molar. The subsequent loi 
teeth, the peculiarity of articulation, and the thinness of the 
process at certain points determine the modifications. In 1 c 
\\-j it will be noticed the laterals are gone; for this reason 




Fig. 142. 




Fig. 1«. 



the centrals arc still in line, space having been made by the 
absence of the laterals: Fig. 143 show- by it- overlapping 
centrals that there was want of space at the time of their 
eruption; the .loss of the second bicuspids subsequently, 

together with peculiarities of articulation, have permitted the 






410 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



lateral halves to assume some curvature. Fig. 144 shows an 
arch too small for the teeth, and is destitute of^the right first 
molar and the left first bicuspid. These were evidently lost 
after the central incisors were erupted. The rest of the teeth 
have migrated more or less because not kept in place by close 
articulation. Thus the cuspids are kept out of place, and by 




Fig. 144. 




Fig. 145. 

their pressure inward tend still more to narrow the arch 
anteriorly. In Fig. 145 the centrals are spread, though the 
process is evidently bent. This spreading is accounted for 
by the absence of the right lateral, which has allowed the cen- 
tral to move backward and the cuspid to move in. On the left 
side we see the cuspid erupted inside of the arch. 

Modifications of the V-shaped arch result from modifica- 



Mil III \l>. 1 \< I . JAWS A\H I I I I II 



i : 



tioofl of the above-named conditions. A difference in the 
time of eruption of the cuspids, everj thing else being equal, 
effects a difference io the space left for their accommodation, 
and thus partial V shaped arches are found. The kej stone 
(the ouspid) is n<>t entirely outside or inside of the arch in the 
partial V shaped form, but may appear partially crowded on! 




Fig. 146. 




of place. Hence the arch is neither a normal curve nor 
wholly angular, but unites the characteristic- ^\' both. It- 
lateral diameter is less than that of the normal arch, giving 

it a contracted appearance. (See Fig. 14»'>. | Thus a number 
of varieties of the fundamental forms of the V-shaped arch 
are formed, differing in degrees of anterior contraction. All 



412 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

of these result from the comparative thinness of the anterior 
portion of the process offering but little resistance, an 
abnormal pressure from behind, and the greater strength of 
the cuspids, which causes them to seek room irrespective of 
the space left for them. By drawing a perpendicular line 
from the median line of the central incisors to the base, and 
comparing the halves thus obtained with our diagram, we 
see that the right half in Fig. 147 is partially V-shaped, while 
the left is normal. Near the apex we have the crowded con- 
dition of the incisor, overlapping the lateral; from thence 
back the curve of the arch is lost. The absence of the first 
bicuspid, together with the want of proper articulation, has 




Fig. 148. 

allowed the cuspid to press nearer the center of the palate 
than is normal. 

In Fig. 148 the V-shape is not so apparent, but the central 
incisors are crowded, which shows that there is not perfect 
harmony between size of teeth and jaw. This contracts the 
anterior arch. 

When one side of the process near the symphysis is the 
stronger, thus affording greater resistance, or the pressure of 
the cuspid is less, that side may maintain its normal relations 
while the other may give way to conditions resulting in a V- 
shaped contraction. The curve will then be broken, not at 
the apex of the triangle, but near it; the incisors will overlap 



I III iih \l'. I \< I :. IAWH \M> I I M II 



•1 1 3 



and wheo pressure from the ouspid acts on the weaker col 

umii it must giveway. This results in tin- snui-V -haped 

form. Pig. 160 

Fig. 151 illustrates a Bemi V shaped arch. The teeth in 
the left dental arch are nearly on i Btraighl line. The teeth 
in the right dental arch are situated upon a Blight curve. En 




Fig. 150. 




Pig. 161. 



this arch the cuspid is in position, while upon the left arch it 
is missing. The posterior teeth have moved forward and 

filled the -pace intruded for the cuspid. It is -till located in 
the alveolar process, and the force produced by the inward 
pressure of the cuspid is so great that the central and lateral 
incisors have been carried forward and the teeth and alveolar 



4H 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



process have produced the straight line. The lateral press- 
ure of the- teeth prevents their being carried farther inward. 
The lack of proper antagonism of the central incisors has 
allowed the cuspid to force the incisor and alveolar process 
forward until the basilar ridge of the right central antago- 




Figr. 152. 




nizes with the mesial surface of the left central. This, in a 
measure, checks the progress of the cuspid inward and holds 
the arch on a slight curve. A perpendicular line drawn from 
the mesial surface of the right central incisor (Fig. 152) to 
the base shows the left side to be V-shaped, while the right 



i 111 in \i». i m i . JAWfl \m» i I i i n 



us 



is normal, [n Fig. L58 the outline does do! loclearlj point 
to r V shaped arch. B) comparing the curvature oi the two 
halves and noting the position oi the right cuspid, it la more 
apparent The bending oi the process at the mesial line is 
evident from the position oi the right central. This has 
turned upon its axis from wan! of lateral antagonism and 
proper occlusion. This partial rotation has allowed the lat- 
eral to move back, occupying in part tin- space oi the cuspid, 
which has forced the cuspid out oi its normal position, caus- 
ing it to erupt outside oi the arch. 

Fig. 164 shows a combination of semi-V and partial V- 




Fig, L5*. 



shaped arches. The cuspid being outside oi the left arch con- 
tracts it and gives it the characteristics oi the V-shape. On 
the right Bide the ouspidis partially crowded out oi place, and 
the arch is somewhat contracted. 



[RREGULARITIES < >r I III U ffl EB i \w . 

The lower jaw never assumes the V-shape when the teeth 

articulate normally, because the anterior interior teeth nor- 
mally close inside of the upper teeth, and. while the force 
from improper occlusion of the jaws and the forward move- 
ment of the posterior lower teeth is as great or greater than 



416 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

the like force exerted upon the upper jaw, the forward move- 
ment of the central incisors is prevented by the striking of 
their anterior surfaces against the posterior surfaces of the 
superior incisors. There are many irregularities of the ante- 
rior inferior teeth caused by the forward pressure of the pos- 
terior teeth. These are quite difficult to regulate, owing to 
their intimate relations with the superior incisors. The infe- 
rior dental arch should be divided into the right and left lat- 
eral arches, corresponding to those of the superior arch. 
The pressure produced by improper articulation and the for- 
ward movement of the posterior columns (the bicuspids and 
molars) is exerted on each lateral half independently, like 
that in the lateral arches of the upper jaw. Each lateral arch 
on the lower jaw has its posterior base (the first permanent 
molar), an anterior base (the central incisor), and the same 
number of stones in position upon the bases — the same key- 
stone — all representing the same number of teeth as are 
contained in the superior lateral arches. The development of 
each inferior lateral arch is independent of the other, as is the 
case with the superior lateral arches. The irregularities of 
the teeth in each lateral arch are independent of the others. 
When the posterior column moves forward, if the key-stone 
(the cuspid tooth) is retarded or slow in coming into place, 
the space is filled by the first bicuspid and the cuspid remains 
outside, precisely as in the superior lateral arches. If the 
pressure of the posterior columns and the key-stone is uni- 
form, the force will be exerted against the anterior base and 
the first stone upon the base (the central and lateral incisor). 
In this case a different condition exists. The anterior base 
and first stone of the superior lateral arch, and the anterior 
inferior column, resist the force. Occasionally, this is so 
great that the anterior columns of both superior and inferior 
dental arches are carried forward. When this occurs, the 
incisors upon the upper jaw protrude. When the forward 
movement of the posterior column occurs, the incisor (or 
anterior column) will crowd past one another like the sticks 
of a fan, provided the pressure be uniform in both lateral 
arches. The six teeth which are instrumental in the con- 



I I \l>. I \< I . I \W - \N !> I I I I II 



H 



struction "t these deformities are illustrated io Big. L55. 
These teeth, as will be observed, are wedge shaped; their 
points ol oontaol are at their cutting edges; slight oblique 
pressure will cause these teeth to lap over each other. It 
the pressure is upon one side only, the irregularity will be 
located on that Bide. One of the common irregularities i- 
mvii when the kej -torn- or cuspid tooth is -low in erupting. 
The posterior column moves forward and the resistance ol 
the anterior column forces tin- kej -stone outside the arch. It 
aometimes happen- that the key-stone moves into place and 




Fig. 16 




Fig. 166, 



is held in position by the anterior column, and the second 
-tone upon the posterior column the first bicuspid) i- carried 

forward outside the arch. This theory can be better under- 
stood by examining cases of this kind which are found in my 
models of the jaw- and teeth, and which will be illustrated 
later. It may be well first to glance at Fig. 1 .'>»;. which shows 
in position a section of the teeth made on the line of lateral 
antagonism. It will be observed that the mesial and distal 
surfaces are convex, and the points of contact are situated at 
the extreme lateral surfaces. If the teeth at eruption should 
not touch at these particular points, or if the force exerted 



418 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



should not be in direct line with these points of contact, the 
teeth would be situated upon an incline, and the force thus 
applied would readily carry the teeth one way or the other. 
Such deformities occur more frequently with the incisor and 
cuspid than with the posterior teeth. The posterior teeth are 




Fig. lb', 




Fig. 158. 

held in position by their contact with the occluding teeth of 
the opposite jaw, while the incisors do not occlude. One 
marked feature of these irregularities is that in most cases 
the lateral incisor is carried inward and the centrals outward 
to remain in position in one or both lateral arches. These 
conditions are fully illustrated in the chapter on local causes. 



I ill HEAD, FACE, JAWS AND TEKTU II :• 

Fig, L57 shows the right dental arch as normal. In the left 
dental arch the anterior oolumn w i 1 1 1 t h«- cuspid (the kei 
Btone) has moved forward, and the lateral incisor is carried 
inward. This i^ explained when the relation between the 
mesial Burfaoe of tin- cuspid and the distal surface of the lal 
era! is understood. In the forward moyemenl of the cuspid 
the lateral impinges upon a markedly inclined plane upon the 
mesial surface of tin- cuspid, and the forward pressure carries 
the lateral inward. Pig. L58 Bhows the same irregularity in 
both right and left lateral arches, the pressure being uniform 

upon each arch. The centrals are also slightly rotated in 

their sockets. This is produced by the Mat lateral surfaces of 
the roots meeting and the pressure of the crown- against the 

basilar ridges of the superior centrals. 

I ill. - kDDLE BHAPED LBCH. 

The saddle-shaped arch is not so common a deformity as 

the V-shaped. It has many of the peculiarities, however, 
that are seen in the Y-shaped arch. It may include one or 
both lateral arches. It may be partial on one side and marked 
upon the other. It may involve the bicuspids and first per- 
manent molars upon one side, or hut a single tooth on the 
other. Each lateral arch produces its own deformity inde- 
pendently of the other. The roof of the mouth may he high 
or low. The deformity, like the V-shaped arch, i- favored by 
the high arch. The following illustration (Fig. L 59) shows 
the manner of the production of this deformity. We see 
lure a right and left superior lateral arch of stone, each stone 
corresponding in size and location to the natural teeth. The 
left lateral stone arch, corresponding to the left superior 
dental arch, show- the formation of the saddle-shaped arch 
and the order of laying the stone- and changing the base. 
The first stone laid in the arch corresponds to the first per- 
manent molar, and, like the stone in the Y-shaped arch. i> 
denominated the posterior base. The next stone laid cor- 
responds to the central incisor, then the stone which >tan«t- 
for the lateral incisor. The natural order then changes, and 
the next stone laid corresponds to the key-stone of the 



420 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



V-shaped arch (the cuspid). It becomes the anterior base, 
forming a fixed point in the anterior part of the mouth. The 
next stone laid corresponds to the first bicuspid, followed by 
those representing the second bicuspid and the second and 
third molars. The stones being in position, we find that the 
auterior and posterior columns are nearly equal in strength 
and resisting power. The anterior column is made up of the 
anterior base (the cuspid), with its long root, backed up by 
two foundation-stones, representing the central and lateral 
incisors. The posterior column is made up of its base, the 
first permanent molar, backed by two foundation-stones, rep- 




Fig. 159. 

resenting the second and third molars. The forward move- 
ment of the posterior column takes place in the arch from the 
same causes which produce the forward movement in the 
V-shaped arch. The stone representing the cuspid is not the 
stone involved; it is almost always fixed in its proper place. 
The weaker stones are those which correspond to the bicus- 
pids, and they are the stones which are always displaced 
w T hen the forward movement of the posterior column occurs. 
The change in the order of the laying of the stones — i. e.. the 
stones corresponding to the cuspid instead of the bicuspid (it 
being irregular) — accounts for there being fewer saddle than 
V-shaped arches. The change of the anterior base will also 



I III 



I \< I . I \W - \S|i I I I I II 



121 



explain w 1 1 \ the anterior column and alveolar process d<> not 
project, as in the case of the V shaped arch. The right 
Buperior lateral arch illustrates another oommon variety of the 
saddle-shaped arch. It does oof differ materially from the 
left lateral aivli as regards the ordei of laj ing the stones. The 
anterior base is transferred one stone back, the Btone corre- 
Bponding to the first bicuspid. The posterior base remains 
the same. The posterior column moves forward and carries 
the -tone representing the second bicuspid inward Bv com- 
paring the shapes of the natural teeth with the Btones in the 
arch jn>t described, we >hall observe that the approximate 
surfaces are convex instead of flat like those of the Btone arch 




Pig. ISO. 

just described. The peculiar incline of the anterior Burface 
of the first permanent molar and the posterior surface of the 
cuspid tooth, together with the oval shapes of the bicuspids, 
are singularly well adapted to cause these irregularities upon 
the application of force. The first permanent molar- arc 
situated farther outside in the arch than any teeth posterior 
to them. The cuspids occupying such a prominent position 
in the arch, in the anterior part of the mouth, the least devia- 
tion inward of the bicuspids would give the pinched appear- 
ance of the jaw at that locality. In neurotics and degenerates 
the jaws will in some cases develop in length and not in width. 
In such cases the jaws at the sixth and seventh year remain 
permanent. The temporary molars hold the permanent 



422 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

bicuspids in the undeveloped position, and the cuspids erupt 
outside the arch. In this way a full saddle is formed. This 
deformity is caused also by the too early extraction of tem- 
porary molars, which allows the first permanent molars to 
work forward and force the bicuspids inward, or by the reten- 
tion of the temporary molars or their roots, thus deflecting 
the crowns of the bicuspids. The question arises, why are 
not the bicuspids forced outward as well as inward ? I would 
reply that they do occur frequently outside the arch; I have 
several among my collection of models. The inward move- 
ment, however, is the natural one, because the crowns when 
in the jaw are situated between the roots of the temporary 
molars. The temporary molars are situated upon a smaller 
circle than the permanent molars and cuspids (see Fig. 160). 
When the temporary molars are extracted, the crowns of the 
bicuspids are in the radius of a smaller circle, while their 
roots have been carried outward by the development of the 
jaw and alveolar process. 

The molars in the saddle and semi-saddle-shaped arches of 
the upper jaw frequently diverge laterally. If the case shows 
a semi-saddle-shaped arch, the divergence is on the side of the 
deformity. If both lateral arches are involved, both sides 
diverge. Cases having the deformity most prominently have 
the most marked divergence. When a slight change exists 
only at the bicuspid region, the divergence in the molar 
region is slight. This peculiar arrangement of the molar 
teeth may be due to two causes: First, the teeth upon the 
lower jaw diverge on account of the shape of the inferior max- 
illa; the farther removed from the incisors, the greater the 
distance between the molars of the opposite side. The molars 
upon the upper jaw usually articulate with those upon the 
lower jaw. The disparity in the appearance of the normal 
position of the teeth and those above described is due to the 
pinched condition in the bicuspid and first molar region rather 
than to the position of the molars. Second, when the arch is 
contracted at the bicuspid region the tongue is limited in its 
movements. In swallowing, the tongue goes to the roof of 
the mouth and is then forced backward for lack of room, thus 



I lit III \l>. I \< I . JAW.s \M' I I ! I II 



\S.', 



shortening uml, consequently, broadening its surface. the 
result of the lateral expansion iroald naturally be to force the 
teeth and alveolar process outward. 

The position of the temporary molars determines the 
position of the bicuspids. This position Bhows the diameter of 




Fig. 161. 




the jaw early in life. From that time until the eruption of 
the third molar, i. *., from the third to the twentieth \ ear— 
the jaw has an opportunity to develop, which naturally car- 
ries the alveolar process and teeth out laterally, causing the 
crowns of the third molar to face the cheek in some instances, 



1L>4 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



DESCRIPTION OF THE SADDLE-SHAPED ARCH AND ITS MODI- 
FICATIONS. 

When there is harmony between the size of the teeth and 
that of the arch, and the permanent bicuspids erupt under 
favorable conditions, so that their greatest diameter is in a 
line with the greatest diameter of both first cuspid and molar, 




Fig. 103. 




Fig. 164. 



they will be held firmly in place, since the greatest pressure 
is on this very line. On the other hand, when the bicuspids 
are erupted after their proper time, while the cuspids pro- 
gress duly, the cuspids, meeting with no resistance, fall into 
their natural position, while the bicuspids erupt inside of the 



arch, forming an angle. 



This angle results from two causes 



ill 111 U>, I \' I . JAWS \M» l I i I 11 







Pig. L6& 




Big. 167. 



426 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

— the thinness of the process at this point and the diminution 
of resistance which must follow. 

Fig. 162 shows a decidedly saddle-shaped arch. The max- 
illary bone is too narrow at its anterior extremity for the 
teeth, which are suited to a more expanded jaw. The consti- 
tutional tendency to this deformity is quite apparent in this 
case. The vault is high and narrow. The first molars are 
pushed forward, leaving only sufficient space on each side for 
one bicuspid. These are therefore turned inward toward the 
palate, making the vault at this point still narrower than it 
naturally is. 

When the unfavorable conditions that result in the saddle- 
shaped arch are not so pronounced, we have the partial saddle- 
shaped arch. Thus, because of the greater uniformity of the 
maxilla and of the arch of the crowns there may be more 
space, and the bicuspids may be forced but little out of place, 
or the molar may move forward but slightly, interfering less 
with the bicuspids. Sometimes it happens that in trying to 
adjust themselves to the limited space one bicuspid may be 
crowded outward and another inward. Sometimes the first 
bicuspid is in, more frequently the second. (Fig. 164.) 

Figs. 165 and 166 show a normal arch on the left side, and 
a saddle-shaped arch on the right. The vault is normal in this 
case; hence there is more room for the erupting bicuspids, and 
less curvature results than is found in Fig. 164. Fig. 167 
shows a similar condition of the left side. 

COMBINATION OF V AND SADDLE-SHAPED ARCHES. 

How the V-shaped and saddle-shaped arch on one side 
only may be produced has already been described. How they 
may be combined on one side remains to be explained. Given 
thinness of process in the anterior part of the mouth, prema- 
ture or tardy extraction of the first molar, and there will be a 
forward movement of the incisors. The development of the 
cuspid will press the alveolar process inward, thereby con- 
tracting the arch, and the tardily erupted bicuspids will adjust 
themselves to the limited curve as before stated. In this way 
the features of the two forms are combined; that is, a con- 



I m in ID, FACE, J LW8 \M> ii El H 






traoted or angulai anterior arch, and ■ posterior arch that ii 
morr or loss concave. The opposite Bide may be V shaped, 
Baddle shaped or QormaL Figa. L68 and 170 

Fig, LB9 Bhowe a combination of V and Baddle shaped 
arch on the left side and V-shaped on the right Figa. L70 




Pig. 168. 




Pig. 1 69. 

and 171 is a case of semi-V and Bemi-saddle-shaped arches 

combined. 

Pig. 172 shows a Bemi-saddle Bhape in the right lateral arch; 

the second bicuspid has been forced inside the arch. The 
opposite side shows a condition exactly reversed. The points 
of lateral antagonism of the second bicuspid are outside the 



428 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 




Fig. 170. 




Fig. 171. 




Fig*. 172. 



Mil II I M». I M I . I \\\ - \M» I I I I II 






long diameter of tin- dental arch. The anterior movement 
of the |K)sti'rior base forced t h«* tooth outward. The tendi 
of this irregularis was to form the V-shaped variety. The 
irregularity of the left lateral arch (Fiflr. L73 is a common one. 




Pig. tm 




Pig. 174. 

The teeth develop normally, but the second bicuspid is either 
retarded in its development or it is deflected inward by some 
local cause. The anterior base is, in this case transferred to the 
Hrst bicuspid. The posterior and anterior bases come together, 



430 ETIOLOGY OF OSSEOUS DEFORMITIES 

and the second bicuspid is crowded inward. The irregularity 
corresponds to the right lateral stone arch of Fig. 159. 

THE SADDLE-SHAPED ARCH OF THE LOWER TEETH. 

The saddle-shaped arch on the lower jaw is generally due 
to local causes, the retention of the temporary molars being 
one of them. The one illustrated is the result of both local 
and constitutional causes. This deformity is also due to an 
arrest of lateral development of the lower jaw. 

Fig. 174 illustrates a saddle-shaped irregularity upon the 
lower jaw. The impression is from the jaw of a man fifty-six 
years of age; the second molars were extracted at the age of 
twenty-two. The irregularity was produced at the time of 
the development of the teeth. The teeth are large and firmly 
set in the powerful jaws. Asymmetry of the jaws exists. If 
they had developed in unison, this deformity would have 
been prevented. The forward movements of the posterior 
columns have carried the cuspids forward and the lateral 
incisors inward, so that the cuspids and centrals stand on a 
line. The second bicuspids and first permanent molars have 
been forced inward by the inclined plane formed by the poste- 
rior surfaces of the first bicuspids, and also by the articulation 
of the superior teeth, which form a smaller arch than the lower 
teeth. As will be seen, the third molars have moved forward 
and nearly filled the spaces made vacant by the extraction of 
the second molars. This forward movement was no doubt 
due to improper articulation with the upper teeth. 



CHAPTER XXXIII. 

LOCAL CAUSES OF IRREGULARITIES OF THE 
TEETH CTPPEB JAW. 

A loot! cause resulting in an irregularity ie found in mal 
position and malocclusion of individual teeth as a result of 
an accident, Bucfa as premature or tardy extraction of tem- 
porary teeth, or malposition and malocclusion growing outof 
constitutional causes. 

Before taking up each form of the irregularity to which 
an individual tooth is BUbject, a few word- Bhould be -aid 
about the relative influence and force of teeth, tor on this 
these irregularities in a great measure depend. 

kki \ii\r. DfPORTANOE <>i iM'iwi'i \l. TEETH in EFFECTING 
tEREQULARITIES, 

Foremost in influence <>n the relative position of per- 
manent teeth i- the first molar. If the temporary molar i- 
extracted prematurely the forward movement of the posterior 

column follow- it. the expanse of the anterior column pro- 
ducing more or less vicious position, relation and occlusion. 
I have frequently observed the anterior movement of the 
temporary molar- and cuspids a- well a- the permanent bi.CUS- 
pids and cuspids, from the great force exerted by the first 
permanent molar, and have a number of models showing 
same. To this even the cuspid must yield, though most 
influential in the anterior column. Next to the first perma- 
nent molar in importance is the cuspid. It asserts itself above 
the rest because of it< vital force, length of root, peculiar 
shape and location in the jaw. The length of it- root allows 
it to deviate more than any other tooth from its original posi- 
tion, because, with the same degree of pressure brought to 
bear on or near the apex of it- root, a tooth may diverge in 
proportion to the length of its root: though the angle is the 
Bame, the divergence grows greater the farther the cusp is 
from the apex. 

181 



432 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

The central incisor comes next in importance, and then 
the lateral. The central incisor finds a support in its fellow 
on the opposite side, while the lateral is the most passive of 
teeth. It, however, plays the part of a co-ordinating force, 
since without this wedge the teeth are not retained in their 
position, and occlusion is disturbed. Because of its weakness 
and short root it is very easily displaced. 

THE CENTRAL INCISOR — IRREGULARITIES PRODUCED BY THE 

MALPOSITION OF CENTRAL INCISORS RESULTING FROM 

FLEXION OF THE ALVEOLAR PROCESS. 

In the chapter on general classes of irregularities the 
fact was emphasized that the forward movement of the pos- 
terior column — i. e., the bicuspids and molars due to prema- 
ture or tardy extraction — will force the weaker anterior 
column and alveolar process forward. The pressure brought 
to bear upon it from both sides makes the arch of the upper 
maxilla greater than that of the lower. As a consequence 
occlusion will be wanting or defective and flexion must take 
place according to the position assumed in the eruption of 
each individual tooth. This condition is greatly promoted 
by the pressure of the cuspids, which, in coming down, assert 
themselves at the expense of the weaker incisors. But this 
is not all. Much depends on the size and the development of 
the germs of the permanent incisors. When there is strong 
vitality their size may be out of proportion to that of the 
alveolar process. Owing to healthy nutrition or the nature 
of the food that is taken into the system during the time of 
their development, the centrals may become very vigorous. 
This more than ordinary development shows itself not so 
much in the relative position of the axes, but in the irregu- 
larities of the cutting edges, owing to the excessive diameters 
of these, which causes them to overlap slightly. When a 
temporary incisor persists too long in its socket, the germ of 
the permanent tooth is embarrassed in its eruption. The 
germ seeks its Avay out as best it can, and as projecting in 
a straight line is out of the question, it slips around the tem- 
porary teeth and is forced partially out Of position. The 



1 III ill \l>. PACK, .l.WV.s W I > I I > I II 






in this case ia do! unlike that of the germ of a plant 

that tcii.- it- wa\ out from under a ~l<«nc 

Having considered the cause of tin- irregularity 
this division, we will now proceed t<» consider its variel 
A form frequently met with is found in V-shaped arches. The 

central incisors arc crowded together BO that their outl 

ed&es tire not in a line, hut form an angle that points for 




Pig. 1; 



xss 



I 



JV '* 




r- T ^ 



■r~ 



Fig. 178. 



Pig. 179. 



175.) This is the most natural form for the 
nine. The arch is -imply broken in front, foi- 



ward. Fig 
flexion to a 

lowing the general direction of the pressure. The mesial sur- 
faces are parallel; the anterior angle points forward, follow- 
ing the general law of incisors. The force i- uniform. Had 
the anterior column not been forced forward by the posterior 
one. these teeth would he normal in every respect. Some- 
times we rind them overlapping each other slightly, and 



131 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

occasionally the anomaly is met with that the general axes of 
the teeth do not converge, but diverge. This divergence is 
found to be due to a faulty occlusion, the lower incisors act- 
ing as a wedge, driving the upper incisors apart, or else, from 
a want of occlusion, they follow their course without guid- 
ance and support. 

In the second class, where the cutting edges form an 
angle which is directed backward (Fig. 176), the pressure from 
behind by the posterior column has met with an obstruction 
in front. This obstruction exists in the center of the alve- 
olar process, and is strong enough to resist in a measure the 
pressure from behind. Hence the force spreads itself on the 
lateral divisions of the anterior process. The result is that 
the mesial line is formed behind the distal line, and an angle 
is formed. Here, as in the former case, occlusion is an 
important factor in determining the position of the axis. A 
want of proper occlusion may force the anterior teeth apart. 
The laterals also in seeking their natural position may help to 
force the distal surfaces of the central incisors still more out 
of line. Being wedged in between centrals and the cuspid 
teeth, the latter, by their greater force, cause the centrals to 
yield to the laterals that are wedged between them. The 
mesial angle of the laterals infringes upon the inner surface 
of the distal angle of the centrals. . These continue to rotate 
until the entire mesial surface of the laterals rests against the 
palatine surface of the centrals. Then the rotation naturally 
ceases, the laterals forming an abutment. Pressure being 
exerted on both centrals, in this way an angle is formed, and 
the pressure on both sides being equal, they are not thrown 
out any farther. The direction of the cutting edges depends 
on the shape of the teeth. 

If the diameters of the cutting edges exceed much those 
of the necks, they necessarily overlap to a greater extent. 

When the two central incisors do not erupt harmoniously, 
one overlaps the other. (Fig. 177.) If, in addition to this con- 
dition, the force that is brought to bear on the anterior alve- 
olar arch is very unequal, certain modifications occur. An 
unequal pressure exerted by the cuspids in-their eruption will 



i hi ill \i>. i m i . JAWS, w D i i i i ii 

force 0D6 aide of the arch farther forward than the other. 
When the firat molar on one side baa been extracted, while 
thai on the other side remains, the forward movement is 
ueoesaarirj one aided, and a corresponding irregularity fol 
Iowa, The tardj extraction of temporary teeth L r '" •- far in 
forcing the germa of the permanent teeth out of place. lrn 
laxity in the lower incisors through faulty occlusion modifies 
greatty the direction of the upper teeth. 

Sometimes centrals projecting in a line in front of the 
laterals are met with. (Fig. L78.) In this case the centrals 
erupted properly; but the arch being undeveloped, there is 
not room for the laterals. These are carried forward by the 
posterior column and in by the cuspids, and arc possibly 
driven in bv the lower incisors, which, instead of striking 




Fig. ISO, 

within them, Btrike without, exaggerating the difficulty. 
When this is not the case, and the lateral- Btrike outside of the 

lower teeth, the upper arch is too Large for the lower, and the 
upper centrals, not finding the proper support below, are 
forced out in a similar manner. 

A similar condition is that in which the central incisors 
strike within the laterals. (Fig. 179.) Thecause is the same; 
but the lateral- in erupting fail to find the proper support 
and project outward, while the centrals occlude properly. In 
this case the upper maxillary arch is not necessarily too large 
for the lower: but the teeth are crowded. 

One form of irregularity that i- occasionally met with 
is that which gives rise to a right angle in the region of the 
cuspids, the incisors being in a straight line. (Fig. 1 v " 
There are. of course, cases <>f this kind where the upper and 



43() ETIOLOGY OF OSSEOUS DEFORMITIES <>I 

lower arches resemble each other, and where the occlusion is 
fair, which, for these reasons, cannot be classed under irregu- 
larities. When this rectangular appearance is found in the 
upper jaw only, it is evidently due to a flexion in the region 
of the cuspids caused by the forward movement of the pos- 
terior column. The anterior alveolar column will be found 
thick, and is therefore capable of resisting the pressure of the 
posterior column, and the pressure is spent on the weakest 
point — i. e., the region of the cuspid. Hence the flexion at 
this point. There is always an excessive development of the 
upper jaw and alveolar process. This causes the teeth to 
erupt too far forward for occlusion with the lower arch, and 
the lip draws them in until they strike the lower arch, and 
the long axes of the teeth point inward instead of outward. 
Thus the vault is brought forward, leaving the lower incisors 
without support. 

IRREGULARITIES PRODUCED BY THE MALPOSITION OF CENTRAL 
INCISORS DUE TO VICIOUS ERUPTION. 

The laws that govern the eruption of the teeth and har- 
monize their development are occasionally interfered with. 
The germs that should be directly over the temporary inci- 
sors may be displaced. These should be situated above and 
anterior to the temporary teeth; but occasionally the germ is 
situated above and deflected posteriorly, and thus it is liable 
to be erupted on the palatine surface. A displacement of the 
germs generally results in vicious eruption; for, however 
slight it may be, as the tooth progresses, the line of its axis 
must diverge more and more from that of its normal position. 
The central incisors spring from a point farther back than it 
should be. If the elevation of the gum is followed, it will 
be seen that these two diverge more and more toward their 
cutting edges. Thus the relation of their axes is changed 
entirely, and a partial rotation is produced. (Fig. 181.) 

Again, if the roots of the temporary teeth persist instead 
of being absorbed as the permanent teeth advance, they mate- 
rially interfere with the eruption of these, and are apt to turn 
them out of their course. When one of -the conical roots of 



I II I III \l 



I V I . I \\\ 



WD I I I I II 



the incisors infringes upon another oof in the same line 
the teeth develop, a tendency to rotation ia established on the 
prinoiple of the screw. Thia partial rotation upon it- axis ia 
more apparent the greater the diameter of the tooth; for the 
catting edge, usually in line vrith the other teeth, non par 
takes of the rei olution of the axis, and bo forma an angle with 
the arch. 

In these three cases, when the tooth ia fully erupted it 
finds a proper resting-place on the opposing tooth: its mal 
position may be corrected by the exercise of it- proper func- 
tion; i»iit it often fails to find this, and projects out, being 

without support. 

Adventitious germs appear occasionally in the alveolar 
process. When these are found in the arch, they necessarily 
disarrange the occlnsion and throw the teeth oul of their 




** ^ \ \ 






proper position. Supernumerary teeth usually appear at the 
median line, and then necessarily crowd all the teeth later- 
ally. Frequently one supernumerary tooth is found exact ly in 
the median line, and centrals coming down to the right and 
left in the arch. 

Occasionally two arc found in the position where the 
trals should be. In Buch cases the central incisors are gener- 
ally located outside and anterior to the lateral incisors. 
When a supernumerary i- found outside of the arch in the 
Indian line, one central may be in position; the other may l>e 
thrown out or in, and may be rotated I.V upon it- axis. 
Fig. 182.) 

IKK1.GULARITIES l'K< >I>1 I ED BY Till. MAl.CoM I U >N I >F I. \ I IK W.v 

1. Mesial surface of lateral overlapping distal surf a 

central, while distal surface i- in a line with cuspid. 



438 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

2. Mesial surface of lateral overlapping distal surface of 
central, while distal surface is behind the cuspid. 

3. Mesial surface of lateral behind the distal surface of 
the central, while the distal surface is in a line with the cus- 
pid. 

4. Lateral in a line anterior to that of central and cuspid. 

5. Lateral in a line posterior to central and cuspid. 

6. Lateral at right angles with the line of the incisor and 
cuspid. 

7. Lateral wholly inside the arch. 

The lateral is found more frequently out of position than 
any other tooth because it is the weakest tooth in the arch 
and has the shortest root, and is therefore more easily dis- 
placed. 

We have seen that the position of the central incisor is 
the combined result of the relative strength of the alveolar 
process, the force brought to bear upon it by the posterior 
column and the cuspid, and the peculiarities of occlusion. 
The lateral, on the other hand, depends for its position on the 
combined force of central and cuspid. Like other teeth, each 
lateral depends upon the environments of its own side of the 
arch, independent of the other. Besides its weakness, two 
other conditions are productive of its change of position — 
(1) the shortness and conical shape of its root; (2) its 
wedge-shaped crown. The shortness of its root, together 
with its conical outline, cause it to be more easily impinged 
upon by the root of the incisor, which will produce partial rota- 
tion. The wedge-shape of its crown facilitates rotation. 
The greater the diameter of the cutting-edge in proportion 
to that of the root, the greater the degree of rotation must 
be before the lateral finds a resting-place. If the diameter 
were equal to the space left, and there were no impinging on 
the root, there would be no displacements. But when the 
space is not sufficient for the lateral and a pressure is brought 
to bear on one side of either cutting-edge or root, there must 
be a partial rotation, which is proportioned to the diameter of 
the cutting-edge. The wedge-shaped character of the crown 
assists in rotation, as the rounded angle of the anterior cusp 



1 III III \|.. I v« 



\W - \M> I I I I II 






offers less resistance than a line or surface. This L r 

to the commonest form of irregular it} Nos. L and 2 I 

: l 1 1 • 1 184), in which ilit- mesial bu the lateral overlaps 

the distal surface of the central, while the distal surfac 

the lateral i> either In a line \n i 1 1 1 the cuspid or just ; * 

of it 

In those cases where the lateral is in a line with the 
cuspid 1 _■ . L85), but its mesial surface is behind the central, 




'V Y - 



Pig. L83. 






J 






Pig. 184. 



Pig. l-.".. 



\ 



, "' i 




the cuspid, having a much broader mesial surface, affords a 
firm abutment to the movement of the lateral, while the mesial 
surface of the latter easily glides over the narrow, rounded 

distal surface of the central incisor, In this case the relative 
diameter of the upper and lower maxillae determines the 
occlusion and position in B measure. If the lower maxilla 
and the upper are properly proportioned the lower incisor 

may strike in front of the upper. 



440 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



4 and 5. Laterals not finding room in the anterior col- 
umn are met with in a line in front of that formed by the 
central and cuspid (Fig. 186), or behind it (Fig. 187). In both 
cases there is no rotation produced by a one-sided pressure 
either upon the root or cutting-edge. Whether the lateral is 
found without or within the line depends upon the relative 
diameter of the upper and lower maxilla? and occlusion. If 
the proper relation exists and the lower incisors strike within 
the upper, the upper laterals will be found outside the arch. 




Fig. 186. 




Fig. 187. 




Fig. 188. 




Fig. 189. 

When the diameter of the upper arch is greater than that of 
the lower, its laterals may be found within the line of the 
centrals and cuspids. In this case the lower incisors must 
either strike over the upper, which occurs when there is a 
proper relation of diameters of upper and lower maxillae, or 
else they may strike behind the upper laterals, which can 
occur only when the upper arch has a greater diameter than 
the lower. 



i in HEAD, FACE, JAWS AND TEETH 111 

6, A rotation of 90 . 90 that the lateral is at right angles 
with a line passing through centrals and cuspids, can occur 
onlv when there is do obstruction to the movement of either 
root or cutting-edge and where there is n<> proper occlusion. 
(Fig. 188, 

7. Occasionally a lateralis found wholly inside <>t the 
arch. Tin- cause is twofold. Sometimes tin- lateral i- 
erupted so tardily that the cuspid pushes it out of its place. 
Then, again, even though it i- erupted, in due time the 
greater relative I Fig. 1 89) size and -t rength <»t' tin- cuspid may 
crowd it toward the palate. 

[RREGULABITIEfi PRODUCED BY THE MALPOSITION "I Till 

CUSPIDS. 

The cuspid La the most important tooth in the anterior 
part of the mouth in regard to durability and influence on 
expression. It owes its durability to the hardness of it- tis- 
sue. Blowness of it- development and simplicity of Bhape. 
The absence of sulci lays it Less open to the inroads of caries. 
The pyramidal Bhape of its cusp u^ives it great power of resist- 
ance. It- strength depends on these conditions and the Length 
of its root, which exceed- that of any other tooth. Owing 
to the Length of it- rool it- cusp may move farther from it- 
normal a\i- without really forming, a greater angle with it. 
It i< placed at the angle between the anterior and posterior 
columns forming the key-tone; hence it i- of the greatest 
importance in affecting expression. The Bhape of the crown 
may vary from the agreeable rounded outline of beauty t<» 
the prominence of the tusk of a wild beast. The Limit 
variation of form and position thus being greater than those 
of any other tooth, it attract- more attention and does more 
to help make or mar beauty. The deviations from it- normal 
position may be due to malposition of the germ or crowding 
out of place. It is difficult at times to determine which of 
these causes product-- the irregularity, though generally it i- 
clear. 

When no source of pressure upon the erupting tooth can 



442 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

be recognized, such as is the case when the cuspid erupts in the 
vault, it is safe to assume the former. 

In both the deciduous and permanent set, as compared 
with other teeth, the cuspids are late in erupting. In both it 
must seek its way between two teeth already erupted; hence 
its liability to be forced out of place. 

The permanent cuspid rarely erupts before the twelfth 
year after the centrals, laterals and bicuspids are in position. 
It is crowded, and therefore meets with obstacles in its descent. 
Its crypt is placed above and in front of those of the lateral 
and bicuspid. As at the age of nine the roots of the incisors 
and bicuspids are pretty well calcified, the cuspid may be 
materially hindered in its eruption by these when there is a 
lack of space. Its conical root makes it yield easily to press- 
ure, and its cusp glides readily over the roots of the adjoin- 
ing teeth. If the relation between the calcification and 
decalcification of the temporary teeth does not take place 
simultaneously a new factor of disturbance arises, for by the 
pressure of an additional obstacle, in the shape of a remaining 
portion of the root of a deciduous tooth, the cuspid may be 
thrown out of its course, while a too rapid absorption of a 
deciduous root leaves the column of resistance broken, thus 
opening a new channel for the erupting tooth. 

The position of its crypt above and in front of those of 
the lateral and bicuspid accounts for the most common form 
of irregularity, i. e., being outside of the arch and above the 
other teeth. The tendency of the cusp is necessarily forward, 
because the combined force of the bicuspids and the first per- 
manent molar from behind is greater than that of the lateral 
in front: hence the lateral is easily pushed out of place. 
Besides, the roots of all teeth naturally pointing backward 
would give it this tendency. 

When in its normal position the cuspid pushes its way 
between the roots of the lateral and bicuspid, and thereby 
spreads the arch, giving it a parabolic outline and forming 
a key-stone; but when it remains outside of the arch, the 
expanded contour is lost and a pinched condition results in 
the shape of a V-shaped arch. The additional pressure of the 



I III Ml \l». I \< I 



.1 \W 



III III 






0U8pid upon the region <»t the lateral only in< -iva-e- this im 

deney. The * ■ 1 1 - 1 » i * l when out of place is usually found al 
and outside of the lateral and bicuspid, this tendency being 
given bj the position of its germ and its caloification I* 
late as compared with other teeth. I Fig. 19< 

One or two cuspids may be found erupted in the palatal 
vault when there is a malposition of the germs. (Fig. L91J 




Ficr. 190. 





I jf. L92. 

I Occasionally it is found outside of the first bicuspid or between 
the first and second bicuspid, sometimes iii front or anterior 
to the lateral. (Figs. L92 and L93. i Frequently it takes the 
place ni the lateral. (Fig. 194.) Sometimes one cuspid is 
found in the palate while the other is on a line pointing inward. 
(Fig. L95. | When it comes through in this position the decid- 
uous cuspid may -till be in position, the first bicuspid having 



444 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



crowded forward to the lateral. (Fig. 196.) Occasionally 
when the cuspid is missing, the lateral will drop backward. 
(Fig. 197.) Its usual position when in the palate is inside the 
lateral incisor, but sometimes it is embedded in the hard pal- 





Fig. 193. 




Fig. 1! 




Fig. lag. 



ate. A pinched condition in the bicuspid region necessarily 
results from such malposition, owing in part to the want of 
prominence of this tooth when in its normal position and in 
part to the inward pressure of the cuspid upon the bone-cells. 



'.Ill III \l». I \« I . JAWS Wl> I I I I II 






(Figs. 198 and 199. When the cuspid moved out of position 
it does so ni til** expense of the first bicuspid and lateral 
incisor. The force maj be w great as to push the lateral 
ward and through the alveolar process. When the cuspid is 
found in the roof of the mouth, <>r out of its normal position, 
the posterior column moves forward, filling tin- space osu 
illv occupied by the cuspid i Fig. 19 1 1, and the half of the arch 
of winch this tooth is a member remains undeveloped. 1 _ 




Fig, i«.»; 




Pig. 198. 




198. i If the cuspids erupt simultaneously the pressure exerted 

is uniform, and there is less Liability to irregularity. < me may 
erupt normally while the other may be abnormal in position. 



HtREGULABITIES PRODUCED BI THE MALPOSITION OF 
BIC1 8PID8. 

The shape of the crown of the bicuspid particularly endan- 
gers it to irregularities of position. The anteroposterior 
diameter of its outer cusp is greater in proportion than that 
of the inner, having a wedge-shaped Bpace on the palatal side. 



446 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



This causes it to touch at one point the tooth in front and back 
of it, and makes rotation upon its axis easy. Irregularities 
are chiefly limited to the second bicuspid for reasons that 
become apparent when we consider their causes. 

Like irregularities of other teeth, irregularities of bicus- 




Fig. 200. 




Fig. 201. 



pids may arise from constitutional causes, i. e., from a lack 
of accord between the size of the jaw and that of the teeth, or 
from local causes. The latter are frequent and come under 
the following heads: (1) Tardy eruption; (2) deflection due to 
the retention of temporary roots; (3) forward movement of 
the molars and (4) rotation from want of occlusion. 



I ill BEAD, i \< i . JAWS AND TEETH 117 

1. Tard The natural order of eruption is: first 
bicuspid; second biouspid; cuspid But this i- distui 

isionally, bo thai the first bicuspid is followed bj the i 
pid, thus pushing it backward. When there is o lack oi 9] 
the second bicuspid must seek itswaj between the first bicus 
pid and the first permanent molar, :m<l if there ia b lack of 
room it is crowded outside x>r within the arch. (Fig. 20 

2. D When :i temporary molar is retained too 
long, or its root i- not absorbed as fast as the bicuspi 
erupted, this obstacle may deflect the bicuspid or cause it to 
rotate more or less upon it- axis, being favored by the spongy 
character «»t' the alveolar pr< 38 Fig. 201. | 

3. The forward movement of the molar- aecessarily dimin- 
ishes the space left for bicuspids and cuspids, and when the 
first bicuspid and cuspid erupt before the second bicuspid, 
this may be crowded out ^\' its proper place. 

I. A rotation of a bicuspid from a want of proper occlusion 
is not rare. An examination of the grinding surface of the 
bicuspid -how- that it i- designed to articulate with an oppos- 
ing tooth. When it- two cusps fail to find an opposing cusp 
to keep them in place it- function is lost and it- fixednes 
position endangered. 

Frequently more than one of these causes arc at work, or 
one implies another. Thus, if there is accord between the size 
of the jaw and thai of the teeth, some of the local causes can- 
not arise; the cuspid may erupt before the second bicuspid 
without disarranging the arch, and a bicuspid may be defl< 
by a deciduous root and ultimately move into place unless 
crowded upon by a -ix-year molar. Rotation may be the result 
of a crowded condition, throwing the tooth out of the arch 
when proper occlusion is out of the question. 

A- the first bicuspid erupt- before the second, it ha- all 
the advantage of Buch -pace a- there is. It may he crowded 
out of place by the forward movement ^^ the six-year molar 
together with the premature eruption of the cuspid. Perma- 
nent deflection due to the retention of a deciduous root is out 
of the question when there i< sufficient space, but rotation 



44^ ETIOLOGY OF OSSEOUS DEFORMITIES OF 

upon its axis from want of proper occlusion may occur here 
as elsewhere. 

The posterior surface of the bicuspid touches the first cus- 
pid only at one point, being an angle and not a surface, and 
this is a fruitful source of irregularity. 

IRREGULARITIES OF THE TEETH PRODUCED BY THE EXTRACTION 
( »F THE FIRST PERMANENT MOLAR. 

Irregularities first attracted attention by the deformity 
they produced, not by their interference with function. 
Overcrowded anterior portions of the arch and displacement 
of individual teeth were noticed. A long time elapsed before 
the results of injudicious extraction were observed. There- 
fore the first permanent molar was ruthlessly destroyed until 
comparatively recent times, producing a large proportion of 
irregularities in the form of malocclusion. This loss of func- 
tion is produced so gradually that the patient is not aware of 
it; he may notice inconvenience in mastication, but does not 
attribute it to the cause, as even persons of great intelligence 
know little about the occlusion of their teeth. 

This tooth has been hitherto sacrificed for two reasons : 
(1) Its early decay, brought about by the tax upon the sys- 
tem of the growing child and the neglect from which the 
teeth suffer, particularly during the period of its develop- 
ment. The parent usually does not know of its existence 
until the child complains of toothache. ( 2) The tooth has been 
extracted to correct an overcrowded arch. 

When removed to stop pain, the pain is indeed relieved 
by extraction, but has in its train many evils hereafter pointed 
out. When removed to correct a crowded arch, tw T ice as 
much space is gained as desirable, and the crowded arch is 
not relieved, as the cuspid, because of the length and strength 
of its root, remains stationary, while the bicuspids move back 
singly or in pairs, leaving the position of the incisors 
unchanged. The disastrous effects of extracting the first 
molar become apparent when its function is understood. We 
cannot do better than ^ive its fourfold function, as stated by 



l ill HEAD, i M i • JAW8 \M» n I ill J !'.» 

i I I avens, of Indianapolis, in the annual of / 
v of 18S£ 

rhe Bret permanent molar baa four distinct functions: 
1 1 • To supply additional Burface for mastication when devel 
opnient has progressed so that the deciduous molars, unaided, 
are no longer competent to meet the requirements of nature. 

ro support the crown- of the deciduous molars when they 
have become unstable, because oi absorption of their roots 
to accommodate the advance of their Immediate successors 
the bicuspids which are usually erupted between the ninth 
and the eleventh years. The deciduous molars begin to 

d Bii i" twelve months before their final displacement. 
Should a permanent first molar be extracted early- saj 
between the seventh and eighth year- the deciduous molars 
supported by it would loosen prematurely so asto be unserv- 
iceable for mastication, and perhajps be lost six to twelve 
month- before the eruption of the succeeding bicuspids. 
To guide the Becond bicuspid into position in event of a loss 
of this molar previous to eruption of the second bicuspid, the 
latter is liable to erupt hack of its true position, or after 
erupting nominally to float backward along the ridge of the 
gum, inclining posteriorly, in such a manner as seriously to 
impair its effectiveness as a masticating organ. This is par- 
ticularly the case in the inferior maxilla. (4) To induce 
additional development of the horizontal portion of the lower 
jaw, immediately anterior to the ramus, in order to make 

i' the eruption of the permanent second molar, and to 
prevent the well-known tendency of the latter to tip forward, 
thus weakening the support of it- roots and impairing it- 
value as a grinder. 

•'The first permanent molar i- supposed l>y many observ- 
ers t" exercise an important influence in establishing a proper 
angle to the inferior maxilla. If such idea is correct >and 
several conditions indicate that it is), it adds possibly another 
to the already long and important li-t of the functions per- 
taining to this tooth." 

The wholesale extraction of the first permanent molar in 
the past has. no doubt, caused arrest of development of the 



45<) ETIOLOGY OF OSSEOUS DEFORMITIES OF 

alveolar process as well as of the maxillaiy bones, for the 
process and jaws depend for their development largely on the 
function of the teeth, their articulation and their motion 
stimulating nutrition and enlarging the arch. 

Some of the older dentists, whose skill is the result of 
routine rather than knowledge, are still to be found extracting 
four sound molars without the least thought of the conse- 
quences. Such a one, who was practicing in a southern par- 
ish not many years ago, was in the habit of taking out the 
first permanent molar in every instance. He said the result 
was u that all the people in that part of the country possessed 
good, regular teeth, and that an irregularity was the excep- 
tion." The author has observed in many cases the want of 
development of the alveolar process, and sometimes the jaws, 
from the extraction of those teeth. This assertion is verified 
in those cases where the orerm has not developed and the tooth 
is missing. More marked instances are those where three 
or four germs are wanting. The loss of a tooth performing 
such a work as the first permanent molar impairs mastication 
and produces vicious occlusion, and is detrimental to the con- 
tour of the face. When extracted before the second molar is 
erupted, one-half or more of the grinding surface of the teeth 
is lost. 

The nutrition of the patient suffers in proportion, and 
health may be seriously impaired because of inability to mas- 
ticate food properly. 

The horizontal portion of the lower jaw will be but imper- 
fectly developed, because function, one of the most important 
means of development, is lost and insufficient room is left for 
the second and third molars. 

When a jaw with deciduous teeth is compared with one 
having permanent teeth, we notice a difference in the length 
of the rami and bodies, and a still greater difference in the 
angles. This difference results from the gradual separation 
near the angle, and is due to the growth of the molars. The 
arches of the permanent set are separated posteriorly by the 
eruption of the first permanent molar. When these molars 
are lost before the second molars are in place, the character- 



i II i HEAD, FACE, JAWS AND TEETH I .". I 

istio angle of the ja^ becomes leas marked. The loss of this 
molar on one Bide only will prodaoe asymmetry of the two 
sides of the face, ootioeable perhaps onrj to the trained eye, 
the parallelism of the two arches having been disturbed. It 
the two are lost early, the jaws approach each other more 
than normally near the angle, throwing the force of mastication 
forward. As the first and second bicuspids do not erupt until 
the tenth or eleventh year, and the deciduous molar- loosen 
six to twelve months before they are displaced, the child is 
forced to masticate its food for several years on a portion of 
the arch designed tor other purposes, compelling these teeth 
to perform the unnatural function of grinding. This confu- 
sion ot' function- produce- hut imperfect results and changes 

the outline o\' the face. 

A- the first permanent molar erupt- it act- a- a fixed 
point, separating and holding the jaws somewhat throughout 
their entire extent, in front a- well, so a- to make room for 
the growing incisors. The deciduous incisor-, being very 
much -horter than the permanent one-, necessarily have a 
shorter bite. When the first permanent molar i- lost the 
natural bite is shortened, for this molar acts as a force which 
lengthens the arches backward and also separates them ver- 
tically. 

When this tooth is lost the lower permanent incisors a> 
they develop strike with greater force against the upper and 
are carried forward. The change at first is imperceptible, 

but in the course of time these teeth will be found spreading 
more or less like a fan. Though the organic relation of the 
upper and lower jaw is not so apparent at first a- that i>i other 
organs, and the two jaws -eem to enjoy greater independ- 
ence, proper occlusion i- indispensable to their health, and 
the teeth in the lower arch are forced out of their sockets by 
a deposit of osseous material not consumed through proper 
function. 

Naturally bicuspids tend to move forward because of the 
inclination of the root and the angle formed by the two jaw-. 
which makes the teeth strike at an angle a- well. This ten- 
dency usually prevents them from moving back, even if the 



452 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 




^fH^ 




Fig. 203. 




Fig. 201. 



nil BEAD, r ACE, JAWS wi- i i i i n 

firs! molar is extracted. When the ouspt are long they usually 
retain their natural artioulation, but sometimes, ai hai b 
pointed out, they more backward. They maj move b 
separately or may drop back together. 1 i _ r 202 This 
dropping back destroys the articulation, causing the oppoe 
in" teeth to strike onlv at certain points instead of bringing 
Burfaces in contact, and frequently partial rotation upon their 
iv - results. 

The most ordinary result of the extraction of this tooth is 
the forward movement of the second and third molars Fig. 

, causing these to tip forward and resulting in vicious 
articulation, as shown by Dr. Davenport in the Dental < 
of July, i sv 7. Externally the articulation may appear not 
to have suffered, but when it is examined inside of the arch, 
it is found that the opposing teeth meet only at certain points, 
becoming thereby partially useless. Fig. 204 Bhows the for- 
ward movement of the first permanent molar. The tempo- 
rary molar- on right Bide are in place, thus holding the first 
permanent molar in place; while on the left side the tempo- 
rary molars have been extracted and the first molar has moved 
forward one-fourth inch. The force of mastication and the 
direction of the roots, together with the eruption of the - 
molar, increases this tendency. 

Length of the rami. body, depth of Bulci of the masticat- 
ing surface and local peculiaritioof the teeth in front, may 
so modify the occlusion as t«» result in bilateral asymmetry, 
and the degree of tipping forward may be quite unlike. 



CHAPTER XXXIV, 

LOCAL CAUSES OF IRREGULARITIES OF THE 
TEETH— LOWER JAW. 

The upper and the lower jaw are quite distinct in char- 
acter, function and course of development, however similar 
they may appear to be. 

The upper when normal describes a portion of a larger 
circle, the teeth overlapping those of the lower. It is fixed, 
and depends for its function entirely on the activity of the 
lower. Owing to this immobility, when irregularities exist 
they are of a more marked constitutional type. Thus we 
have the various abnormal arches not seen in the lower; the 
high and narrow vault and the inward curvature of alveolar 
processes. It has a greater sweep of development, and con- 
sequently greater possibility of irregularity in its anterior 
columns, because these are unrestricted; while the lower is 
restrained by the overlapping of the upper teeth. The lower 
jaw is hung loosely, but firmly by its condyles, permitting 
motion in three directions — antero-posterior, vertical, and 
lateral. 

In Fig. 205 the six anterior inferior incisors are shown. 
Observe that the points of contact are at their cutting edges, 
the mesial and distal surfaces being rounded, which enables 
them to crowd easily past each other when force is applied; 
the roots are flattened at their sides, so that when pressure 
is brought to bear upon them they move with readiness over 
a considerable distance. That the pressure cannot well be 
exerted in a straight line through the posterior column, and 
from thence extend in a curve through the anterior teeth, 
appears from the law of simple forces, which act in straight 
lines only. The cuspid, finding no resistance in front, but 
being resisted by the incisors slightly at the side, must neces- 
sarily pass forward. The lateral is too weak to afford resist- 
ance. Even if the centrals could be acted upon by the 
pressure from behind, they could be prevented from assuming 

454 



1 III HIM*. » \' I . JAWS \M' II 

i V shape bj the overlapping incisors above; for the more 
the upper arch i- compre-sed laterally, and the mesial angle 
of the central is turned outward, the more will the distal angle 
be turned inward, and thus confine the lower incisors. 

The lower incisor- being narrower than 1 1 1 « - upper onlv 
favors this tendency. Theae conditions are necessarily mod- 
ified by the local peculiarities of the upper arch, the relal 
strength of the teeth and the nature of the occlusion being 
all-important factors in determining final results. 

1 _ 206 is a diagram of a normal lower maxilla. The line 

sses through the cuspids, bicuspids and molar-, and 

shows tin- direction of the force exerted by the posterior col- 




306. 

umn upon the anterior. For it- growth it depends far more 
upon function than the upper. The growth of the lower jaw 
is limited to the posterior column, as has Keen mentioned. 
this being accomplished by the absorption of the anterior 
border of the rami, while bone-cells are deposited along its 
posterior border. Itsfreedom of motion is, however, retarded 
by the arch of the upper maxilla, for which reason irregular- 
ities are much rarer in the lower than the upper jaw, as the 
overlapping of the upper teeth tends to correcl any predispo 
>ition to malarrangement 

Irregularities of this jaw result more from local causes than 
those of the upper maxilla, except those found in the under- 
hung jaw. It- development depend- largely on mastication. 
Owing to its movements there are fewer irregularities in this 
maxilla and the jaw is more apt to he normal. Irregularities 



456 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

back of the cuspid are very rare. Occasional contractions of 
the lower arch occur, such as dipping in, which is due to 
peculiarities of occlusion. When cases of irregularity exist 
they are generally found in mouths the lower arch of which 
exceeds the upper in diameter, thus permitting less firm 
interlocking and greater freedom of individual teeth. 

When the diameter of the circle of the teeth of the lower 
jaw exceeds that of the upper, its lateral movement causes an 
enlargement of the upper circle by opening the median 
suture, this condition being indicated by the spreading of the 
superior central incisors. As has been shown in the chapter 
on migration of teeth, twisted bicuspids often result from 
entire want of occlusion or the touching of two opposing 
teeth at only one point. The most frequent form of irregu- 
larity is a crowding of the incisors. This is generally the 
case where the size of the teeth and the jaw are not in har- 
mony, and is due to two causes: (1) The teeth of the lower 
jaw are forced inward by occlusion, the diameter of the circle 
of the upper teeth being usually the smaller; (2) The forward 
movement of the posterior column. 

The two halves of the lower arch, like those of the upper, 
for obvious reasons do not present the same forms of irregu- 
larity. Like the upper jaw, the lower is subject to forward 
movement of the posterior column. A want of harmony in 
the development of upper and lower maxillae produces a 
crowded condition of the lower arch, resulting in pressure 
upon the anterior column. 

The direction of the roots of the lower molars greatly 
increases this tendency. When the crowns of the second and 
third molars are erupted the first molar is pushed forward. 
The pressure is exerted principally through the posterior col- 
umn upon the cuspid, and is in a straight line. This tooth, 
by virtue of its rounded cusp, slips by the lateral and is pro- 
jected forward often beyond the central incisors, leaving the 
lateral behind. 

Like the upper maxillae the two halves of the alveolar 
arch are separate, and are* modified independently. An irreg- 
ularity on one side by no means indicates a. similar irregular- 



I III Mi \l>. I \< I . JAWH \M' I I I I II 



it\ .mi the other, owing t<> the difference of pressure thai rnaj 
be exerted. 

Fig, 907 shows the left dental arch normal, bat tin- for 
ward movement of the posterior column has caused the right 



1(*£&&S 







!':_'. 20; 




Pig. 309. 



V 



Pig. 210. 



lateral to fall behind. As the two columns converge anteri- 
orly they exert their pressure in this direction, inconsequence 

of which we find irregularities of the lower jaw confined for 
the most part to the region of the incisors. 



458 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

Though, as stated before, the laterals are generally pressed 
within, while the centrals occupy their usual position, these 
teeth may stand at various angles, Avhich are determined by 
the local peculiarities of the teeth of the upper maxilla. Thus 
it may happen that a cuspid or a lateral may strike outside of 
its antagonist of the opposite jaw. 

Fi£. 20S illustrates a common form of irregularity, in 
which both posterior columns have moved forward. The lat- 
erals are crowded backward and inward. The lines of force 
are also directed inward, but a V-shaped arch is prevented by 
the lower centrals striking against the palatal surfaces of the 
upper centrals. If the cause of this form of irregularity is 
borne in mind it will be understood why the extraction of a 
lower lateral or central makes this form of irregularity still 
worse, inasmuch as it disarranges the occlusion of the cuspids. 

In Fig. 209 we see the right dental arch normal. The 
left posterior column has pushed against the lateral, and 
meeting with sufficient resistance, the central is carried back- 
ward. While erupting, the central was carried inward, 
owing to a want of harmony of development. Two centrals 
have been found directed inward, though this form of irreg- 
ularity is rare. 

Fig. 210 shows the left dental arch normal. The forward 
movement of the posterior column on the right side has 
caused the cuspid to advance beyond the line of the incisors. 
The rotation of the cuspid upon its axis caused it to pass by 
the lateral, leaving it in position. This is a common form of 
irregularity. Occasionally the cuspid is carried forward in 
the direction of the pressure. Such a case is illustrated in 
Fig. 211. The left lateral has been carried inward in the 
manner already described. The posterior column has pushed 
the cuspid on the right side laterally so that it occupies the 
position of the right lateral, and the bicuspid is carried for- 
ward and outside of the arch. 

THE INFERIOR CUSPID. 

The cuspid erupts in line with the other anterior teeth 
unlike the upper, the crypt of which is above and outside of 



I III III M>. I \< I . I \\\ - \\|. I II 1 II 






tin- lateral incisor and bicuspids. For this reason and the 
fact that the upper cuspid tends t.> keep it in position by 
occlusion, irregularities of the cuspid "t the lower ja* are not 
so common as those of the upper. When tin- tooth is found 
(mh of line, it i- anterior of its normal position, rarely 
ever, posterior. Its eruption ma\ be tardy, giving the 
advantage <»t time t<> the upper cuspid and directing the lower 
cuspid outward. In a crowded jaw a « 1 i -.1 rm n lt< i m-nt of the 







i 



Fig. 211. 




Fig. 215 



incisors may follow, leaving the lateral almost directly behind 

the cuspid, a- in Fig. 211. When there is a malposition of 
the CU8pid on one side of the maxilla, the CU8pid of the oppo- 
site is usually pushed forward, a- seen in the -aim' illustra- 
tion. 

Owing to a malposition of the germ, the cuspid may he 
found outside of the incisor- in the median line (Fig. 212 
even inside of the arch (Fig. 213). Rarely it is found on 
the median line between the incia >rs, a- Bhown in this illus- 
tration. 



160 



ETIOLOGY OF OSSEOUS DEFORMITIES OF 



LOWER BICUSPIDS. 

Like the cuspid, the position of the bicuspid is most fre- 
quently affected- by the forward movement of the posterior 
columns. An irregularity in a lateral direction is rare, since 
the density of the lower maxilla is unfavorable to this. 

Whenever a bicuspid is found without or within the arch, . 
it is due to the undue retention of the temporary teeth. 




Fig. 213. 




Fig. 214. 



Fig. 215. 



Fig. 214 shows the second bicuspid situated inside the arch, 
while Fig. 215 shows the first bicuspid inside and the second 
bicuspid outside of the arch. Twisted bicuspids occur fre- 
quently from a want of proper occlusion, when the space 
yielded by the lower jaw is larger than that of the upper, 
or when the first molar is extracted. 

When the second temporary molar is retained too long, 
the first permanent molar may be pushed forward, thus con- 
fining the bicuspid and preventing it from erupting. 



i iii 111 \i». i \< r. JAWS am- i i i i ii MJ1 

mi«.i; \iiu\ Ol i i i i ii. 

Thai teeth move when noted upon bj some external force 
is known to everj practitioner, and ie utilized in his opera- 
tions t>\ producing temporary separations, in regulating and 
the like. Whj they Bhould move from their normal position 
without any apparent cause is not bo easj to explain, and 
theories have been recently advanced to account for this. It 
la obvious that when the arch of the alveolar process is greater 
than that <>< the combined diameters of the teeth, there musl 

be a -pace or -pace- -oinew here. This -pace is usually equally 

distributed among the anterior teeth. Sometimes, however, 

-pace- ate found that disfigure the mouth, and besides these 
we find occasionally one or more teeth that appear to have 
rotated upon their axes. An inquiry into these forms of 
motion is the province of this chapter. 

This subject is best considered under two heads: A Per- 
fect occlusion; 1 1>* proper relation between waste and repairs. 

A If the occlusion ^\' the teeth is perfect, so that each 
tooth is kept in place by its adjoining neighbors and the 
opposing tooth, dislodgment is impossible. All teeth Bhould 

touch those adjoining them at the extremities of their greatest 
diameter. This allows a slight lateral motion. 

Good occlusion differs according to the function of dif- 
ferent teeth. Their shapes indicate this. The upper and lower 
incisors overlap each other, producing what is termed the 
overbiti . In the normal relation they strike in a straight line. 
which passes through their roots. The curved lingual sur- 
face of the upper incisors allow- for their Bliding into this 
position. The force being thus exerted in Btraight line-. 
there is a con-taut tendency to keep them in position, and as 
the pressure upward and downward i- vertical, spreading of 
the upper incisors is impossible. The relation of cuspids is 
similar. Quite otherwise with bicuspids and molars. Begin- 
ning with the bicuspids, we find the cusps of the first superior 
bicuspid striking not over that iA' the first lower bicuspid 
alone, but over the angles formed by the distal side of the 
first lower and mesial side of the second. Each tooth begin- 



462 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

ning at this point is not only in relation to one below, but to 
two, and when one of these teeth is extracted the order of 
the mouth is disturbed, and a rearrangement of some kind 
usually follows. What this will be depends on a variety ot 
circumstances. 

A typical example is furnished by the extraction of the 
first molar. Every practitioner has observed the forward 
movement of the second molar as a consequence. A tilting 
forward of this tooth results. The reason for this is obvious 
when we remember that the posterior cusp of the first upper 
molar strikes the anterior cusp of the second lower and exerts 




Fig. 4ti5. 

its whole force, which was meant to be distributed on both 
cusps, on it. 

(B) The position of the teethis not determined alone by 
the relative size of the maxillae and the occlusion of the teeth. 
Nutrition and absorption, waste and repair, play an important 
part. On the perfect harmony of these the beauty and health 
of the teeth depend. Changes in the position and removal of 
bone-cells go on constantly and vary with the age and other 
physical conditions of the patient. This disposition and 
removal of bone-cells is seen in the changes that the lower 
maxillae undergo during different periods of life. When the 
deciduous teeth are replaced by the permanent ones, the arch 
of the jaw becomes more pronounced, and there is a lengthen- 
ing of the alveolar ridge backward to accommodate the 



i ii i ii i M>. FACE, JAWS \M> i i l i ii 

molars, When the senile changes take place the angle of the 
jaw becomes more obtuse. Thai there is a similar adjust 
ii i« -i 1 1 to oircumstances going on constantly is proven bj cir 
cumstan ; ►rrection of irregularities depends on this. 

The position of the teeth in tin- alveoli is determined solelj 
i>\ tin- tissues around it. By producing a pressure in a given 
direction, bone cells may be removed on one Bide and others 
deposited on the other and the position of the tooth chang 
The change in the deposit and removal of osseous matter is 
imt unlike that of the deposit of particle- of earth in the bed 
of :i river where -take- have been placed for the purpose of 
Locating the bed of the river. By the successive deposit and 
removal i>\ these particles the position of these may be 
changed and even the current of the river. This illustration 
may help to make clear changes in the contour and density of 
the alveolar pro lepending on the changes of blood- 

supply and absorption. Irritation may thus stimulate the 
activity of the capillaries to a more than ordinary degree of 
repair. 

Every tooth exert- a pressure of it- own in different 
directions. Were this not so it would be difficult to account 
for the elongation of a tooth when its opponent is extracted. 
This pressure is healthy and implies the antagonism of oppos- 
ing: teeth. If this occlusion is wanting, the relation <^ v 
and repair i- disturbed. An excess of hone-cell- i- often 
depo-ited a- a result. 

When these two fundamental law- ot good occlusion and 
balanced waste and repair are violated one of the three fol- 
lowing condition- may follow: 

1. The movement of individual teeth in straight line-. 

2. The rotation of individual teeth upon their av 

3. The forward movement of groups of teeth and the 
alveolar processes supporting them. 

THE MOVEMENT OF INDTVID1 AX. TEETH IN STRAIGHT LINES. 

It was >tated above that when the alveolar processes and 
teeth correspond in size ami the occlusion is good, that Bj 



464 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

between the teeth are out of the question. Sometimes a space 
is found between the central incisors. If the occlusion is 
good otherwise, this space is due to a continuance of growth 
at the margin of the suture — i. e., there is a greater deposit of 
osseous material than is needed, producing a larger diameter 
of the jaw than the teeth. This begins usually at an early 
period in life, and continues till the growth of the osseous sys- 
tem has ceased. As the jaw develops in the child while the 
temporary teeth remain, it is but natural that spaces should 
be formed in time until the permanent teeth take their place. 

Spaces may be artificially created in time by forcible 
separation by means of wedges. In former years, when more 
force was applied by dentists, irritation w T as created, and 
absorption on one side induced. In this way several teeth 
were sometimes crowded in one direction. When the anterior 
incisors do not strike on a line, but at an angle, so that the 
cutting-edges of the lower incisors strike against the inclined 
plane of the lingual surface of the upper incisors, an out- 
ward pressure is exerted and the incisors separate. The 
spaces that are so frequently seen in the permanent incisors 
in children are in many cases produced by the tardy eruption 
of the cuspids. When the cuspids come down into place these 
spaces disappear. Spaces are rarely if ever observed between 
molars. 

Again, the lower jaw, if too large for the upper jaw, may 
act as a wedge, and by striking against it may spread the 
central suture. The spaces between these teeth are usually 
found to be healthy. It is not reasonable to suppose that 
either salivary or germinal calculus or inflamed gums could 
produce this motion. Were the pressure exerted on one side 
only there might appear to be some ground for this supposi- 
tion, providing calculus exerted a pressure too great for the 
rest of the teeth to resist. But when calculus is deposited on 
both sides the pressure exerted would be counterbalanced and 
lateral motion could not take place. Those who hold this 
opinion are probably misled by the fact that a tooth may be 
dislodged by calculus from its socket vertically. But this is 
in accordance with mechanical principles. In this case the 



i 111 in \i>. I \< r, JAW8 IND i i i i m »•■■• 

calculus diminishes the diameter of the socket, and the wedge 

>ha| >e. I n »ot is f( >rer. I i «iil . 

K, .t\ riON Ol INDIVIDUAL TEETH 1 PI >N I HEIH IXE& 

When a tooth touches its opposites only al one point, or 
thr opposing tooth was extracted, as it frequently bap] 
with bicuspids, in-trad of articulating with surfaces, rotation 
may result In this case bone-cells are deposited on one Bide, 
while those at an angle with these are removed. This pro 
duces b Blighl rotation which tw ists the tooth. Thai this pro 
oess i- physiological, is proven bythe healthy state of the 
gums and alveolus which is found in mosl of these cases. 
Fisr. 216 not only Bhows the rotary motion to the bicuspids, 
but also spontaneous motion in direct lines a condition fre- 
quently obsen ed i>\ the author. 

l in n u;w \i:i> M< A EMENT OF GBOUP8 OF TEETH AND Tin: \i \ I 
oLAi: PROCESS BUFFORTING THEM. 

In young persons, when the blood supply is rich with 

nutritious material, and when waste and repair go on rapidly, 
the four and sometimes six anterior teeth and alveolar pro- 
cesses are carried forward. This proper occlusion with the 
inferior incisors becomes impossible, and these become elon 
gated, and, foiling to find a support in the upper incisors, 
strike against the roof of the mouth. Irritation is produced 
and an excessive flow of blood to the parts follows. Thus 
we have: 

ANTERIOR PROTRUSIONS FROM CONSTITUTIONAL AM) LOCA1 

I LU8ES. 

One of the most interesting forms of irregularity is that 
in which the inferior incisors impinge upon the mucous mem- 
brane of the roof of the mouth and the superior centrals, 
laterals, cuspids and bicuspids, having moved forward. pro- 
jecttO Mich an extent that the upper lip cannot close OVei 
them. It should l»e observed: 

1. That these cases are not confined to normal individu- 



466 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

als. but are found among idiots, deaf and dumb, blind, 
demented and insane. 

2. The deformity is not seen in temporary teeth, but is 
confined to the permanent set. beginning at the seventh or 
eight year and increasing with age. When not corrected the 
teeth will finally project at an obtuse angle, as is illustrated 
by a case of a woman fifty-five or sixty years of age that 
came to our notice, whose teeth projected almost horizontally. 

3. The vault connected with this irregularity is usually 
low, though sometimes high, in which case it is more pro- 
nounced: just as V and saddle-shaped arches are more pro- 
nounced when associated with a high vault. 

4. The irregularity begins at the central incisors, extend- 
ing backward. 

5. Generally later in life tartar collects around the roots, 
and Riggs 1 disease sets in, exaggerating the condition. 

6. In the majority of cases the superior maxilla is 
arrested, and the teeth project at an angle of 20°, carrying 
the alveolar process with them, in order that they may strike 
over the lower incisors. 

Dr. Kingsley, who first described this form of irregularity, 
is right in his statement that this condition is neither inherited 
nor the result of thumb-sucking. The conditions under which 
this irregularity is brought about are both constitutional and 
local. It should be noticed that the excessive proliferation of 
bone-cells does not begin before the sixth or seventh year, 
hence not until the permanent teeth are erupted. A want of 
balance of nervous function, resulting from neurotic condi- 
tions or a transmitted tendency to disease, may interfere with 
the centers of ossification, which interference, as has been 
shown, frequently finds expression in the anterior part of the 
mouth, sometimes producing a high vault, contracted arches, 
excessive or deficient deposition of bone-cells. The condi- 
tion- are mostly confined to neurotics and degenerates. An 
excessive proliferation of bone-cells near the median line of 
the superior alveolar process tilts the axes of the erupting 
centrals slightly outward. This direction once being given 
to them, when the lower incisors strike against them they do 



I III III \l>. I M I . I \W - \M> I II I II 



»»:: 



doI find the resistance of correct occlusion, but sol upon 
them as upon an inclined plane, throwing them out more and 
more during the process of eruption. This musl necessarily 
terminate in striking the process itself; increased activil 
nutrition which irritation sets up, resulting in excessive 
development, which also Bhpws Btigmata of degeneracy. The 
tiltim: forward of the upper incisors increases the distance 
between them, and the tower incisors do not find the resist- 
ance belonging to natural function. The consequence is the 





Fig. 811 



Fig. 218. 




HP 






elongation of the lower anterior alveolar arch, a circumstance 
to be noted in these cases. The eruption of the first per- 
manent molar- (letermines the relation of the jaws to each 
other; occasionally they do not develop their full Length. In 
either case the lown- incisors Btrike against the mucous mem- 
brane of the "roof of the month, which constant irritation 
stimulates the deposition of the bone-cells in the process, as if 
nature would defend it against the abnormal pressure of the 
lower teeth. Were the occlusion correct, the constant pressure 



4<;s 



ETIOLOGY OF OSSEOUS DEFORMITIES 



on the roots of the teeth would doubtless, in part, counter- 
balance the excessive deposit by waste. As it is, the roots of 
the upper incisors form an angle with the cutting-edge of the 
lower teeth, and as the mouth opens and closes, the force of 
the lower incisors is not only spent on the superior process, 
but also through it on the roots of the upper teeth, forcing 
them out more and more. Fig. 217 shows the starting-point. 
The central incisors have just commenced to move forward. 
The model is from the mouth of a girl eleven years of age. 
The trouble is extended to the neighboring teeth from the 




Fig. 220. 



nature of the occlusion. Fig. 21S shows the incisors and alve- 
olar process carried forward by the excessive deposition of 
bone-cells. By the action of the lower lip, which cannot close 
over the cutting-edges of the upper teeth, but soon gets 
between the superior and inferior incisors, the former are 
pressed out still more. Fig. 219 shows a side view of this 
form of irregularities. Fig. 220 illustrates a remarkable 
case of migration of the molars. 

Want of function encourages a deposit of tartar around 
the roots of the teeth, inducing Riggs 1 disease later in life 
and loosening the teeth. 



CHAPTER XXXV. 
SUPERNUMERARY TEETH. 

Supernumerary teeth are b freak erf nature, for which do 
caint ha-, u yet, been assigned. It may, of course, be si 
that additionaJ genua writ- formed during foBtal life, but this 
is do true explanation, for the question -till arises, "What 
caused these '." 

Plants put forth adventitious buds and -how monstrosities 
in all their organs; animals arc not always developed accord- 
ing to the law of their species; the human race -how- mon- 
strosities in every organ. It i- therefore not to be wondered 

at that we Bee additional teeth. They were noticed by the 
earliest writers ^n dentistry, even before Christ There is no 
doubt that what the public calls a double row of teeth is often 
merely malposition of the regular number, and that many a 
supernumerary tooth, when well formed, escapes notice. It 
i- best, before making a statement in doubtful cases a- t«> the 
class to which the supernumerary tooth belongs to take an 
impression; then it can be studied and compared with the rest 
at leisure. 

Deviation from the normal number is more marked in the 
permanent than in the temporary set. Little mention has 
been made of deviations in number in the deciduous set, 
because more rare, and because the deciduous teeth have less 
individuality than the permanent ones, which would cause an 
additional tooth to escape notice. The author has cqmeacross 
tour cases in hi- practice of supernumerary laterals in decid- 
uous teeth. Three of these cases presented a supplemental 
lateral on the right side (Fig. 221); the fourth had them on 
both -ides. It is interesting to notice that the excess was 
found mostly on the right side, for the reason that neater 
development of organs ^n the right side, including the jaw. 
have hitherto been ascribed to more frequent use. A- the 
germs of the temporary teeth are formed before birth, this 
theory cannot stand in this instance at Least. 



470 



ETIOLOGY OF OSSE< H - DEFORMITIES OF 



When we come to the permanent teeth we find a distinc- 
tion between cases presenting merely a variation in number 
and those showing malformed supernumerary teeth. These 
may be considered under the heads of supplemental teeth and 
monstrosities. The former are like normal teeth, and it is 
difficult to distinguish them from these. The contour of the 
latter, like that of all monstrosities, is governed apparently 
by no law, excepting a want of definiteness. However, the 




Fig. 221. 




Fii 



root is conical and the crown may be lobed or have the appear- 
•ance of having been partially folded or poorly formed. 

Adventitious teeth are more frequently found in the upper 
jaw than in the lower. It is a rare thing to rind a well-formed 
supernumerary central incisor. The author has a cast show- 
ing five equally well- formed incisors in the lower jaw. 
Whether the supernumerary tooth is a central or lateral can- 
not be determined by the form. Coleman records a case 

the upper jaw. 



having four well-formed central 



incisors in 



i ii r in \i -. i \< i . i \\\ «. \ m i i i i i ii 



171 



Partial!} developed additional incisors are oof rare. These 
teeth :nv found .-it different angles. The} are Been erupting 
behind the arch, In front of it, or between two other teeth. 
Fig. 222 shows a conical tooth between two ill-shaped ceo 

trals. one of which -land- almost at r i i_r 1 » t angles with tin* 








Fii 



arch. Another rase still more interesting (Fig. 223) has two 
central monstrosities separating the legitimate centrals. Fig. 

224 shows t wo supernumerary centrals, haying the appearance 
of being convoluted, between the usual centrals. In Fig. 

225 we sec two supernumerary centra] teeth between the lat- 
erals, all of which are placed inside the regular arch. 



47i> 



ETIOLOGY OF OSSEOUS DEFORMITIES < >1 



Laterals in excess are not so common as centrals. These 
are usually more like the normal teeth. Sometimes they are 
found on both sides. Fig. 226 shows a lateral behind the 
arch and between the central and the lateral. In the lower 
jaw they are rare. 

In Fig. 227 one of the supernumerary laterals is placed back 




Fi 2 . 220. 




Fig. 22 



Fig. 228. 




Fig. 229. 



of the right cuspid and at right angles with it. The author 
has two models similar to this in his collection. Cuspids, 
bicuspids and molars are not often found in exec— 

Fig. 22S shows a supernumerary cuspid, twisted upon its 
axis on the right side of inferior maxilla. The right lateral 
is missing and the cuspid is, no doubt, a malformed lateral. 



l in iik kD, PACE, iaw - INI) I li l H 






although ii has the appearance of i perfect cuspid. Id 
Pig, 229 ire Bee i dentil anomaly i<> winch attention li 
directed by Dr. Rickey, of San Franoisoo. In this case it ii 
difficult to Bay which is the lupernumerarj tooth. Fig. 280 
Bhows four well formed molars in each Bide. 












Fig. 231 illustrates a very rare case of supernumerary 

teeth, eight in all. They do not seem to be confined to any 
one class— incisors, cuspids and bicuspids seem to be dupli- 
cated. This cut certainly illustrate- a double set of teeth. 
The model is in the Pennsylvania College of Dental Surgery. 



CHAPTER XXXVI. 

MISSING TEETH. 

That teeth are frequently missing is observed by every 
practitioner of dentistry. It is often difficult to decide 
whether the germ ever formed or the tooth is simply imbed- 
ded in the alveolar process. Because the crown of the tooth 
is not in position is no sign that it did not develop. The 
order in which the teeth are more liable to develop and 
become imbedded in the jaws, as observed by the author, are 
first, cuspids; second, third molars, and third, bicuspids. 
There are good reasons for this— the fact that the order and 
manner of development of all the teeth, and the development 
of the jaws, reduce the space for the advancement of the cus- 
pid, bicuspid, and third molars, thus causing difficulty for 
their eruption. 

The teeth which most frequently develop and become 
imbedded in the jaw are first, cuspids; second, bicuspids. 
This is due to the fact that owing to the forward movement 
of the posterior teeth or other causes, the germs become dis- 
lodged from the natural position and point in another direc- 
tion, thus becoming entangled between the roots of the teeth 
anterior and posterior, and in this way are unable to erupt 
into the mouth. The teeth whose germs are most frequently 
undeveloped are first, third molars, and second, lateral inci- 
sors. The author cannot account for this want of development 
in any other way than that it is the result of stigmata of 
degeneracy. Some time ago, out of 670 examinations forty- 
six per cent of missing third molars, and fourteen per cent of 
missing laterals were found. In most cases the missing molars 
were upon the upper jaw and upon both sides, while the miss- 
ing laterals were always upon the upper jaw, and in most 
cases only upon one side. 

At the time of the examinations, it occurred to the author 
that it was a very large percentage, but since that time and 
while making further observations, he is confident that they 

4T4 



! BAD, i \« i . i \\\ - \\i. i i i i ii 

:uv always found in neurotics and degenerates, and that the 
reason of such a large percentage is due i«> the fad that my 
practice is made up largely of people w 1 1 < » require Bpecial 
treatment It would i>r impossible to -;i\ that all of these 
germs did not develop, or thai they did and the teeth became 
imbedded intheja* for reasons already stated. Forourfnir 
. it makes no difference in either case, the cause is arrest 
oi development, the one of the germs, the other of the 
and both are due to the same cause neurosis or deg< 



CHAPTER XXXVII. 

THUMB AND FINGER-SUCKING. 

In the chapter on refutation of old theories regarding the 
etiology of irregularities of the jaws and teeth, the author 
has stated his reasons why the high vault and the V and sad- 
dle-shaped arches cannot be ascribed indiscriminately to 
thumb-sucking, as has been the custom. 

Hitherto the greatest confusion of ideas has been current 
among practitioners as to the etiological differentiation of 
these cases. It behooves the author to describe the condi- 
tions that are due to thumb-sucking in such a way that the 
student may be aided in making a diagnosis. In cases of 
irregularities due to thumb-sucking we find several teeth and 
the alveolar process brought forward. Frequently spaces are 
found between them, so that they stand out more and more 
fan-shaped. The vault may be high, but is usually low like 
that seen in Fig. 234. The teeth are frequently affected only 
on one side, the shape and extent depending upon the direc- 
tion of the force and the hand employed in sucking. In the 
V-shaped arch the teeth are crowded and point toward the 
center, owing to a force applied by the posterior column and 
spent on both halves toward the median line. The vault may 
or may not be arched. In the saddle-shaped arch the teeth 
are crowded, except in cases due to hypertrophy, and they 
stand perpendicular. The vault may be high or low. In 
cases of thumb-sucking, the teeth of the inferior maxilla do 
not articulate properly with the upper, and are often turned 
inward, which is caused by the pressure of the thumb upon 
the cutting-edges. We see from this that the distinguishing 
feature of a case of thumb-sucking is the spreading of all or 
a part of the anterior teeth, and that the lower teeth are 
usually turned inward. 

When the vault is high, it is quite marked in the anterior 
portion of the roof of the mouth; but this is by no means a 
characteristic feature. As the habit of thumb-sucking usually 



I III III \l>. I \< I . .1 \\\ -• \M» I I I I II 

terminates before the eruption of the permanent teeth, • 
of irregularities resulting from thumb rooking in children 
over icn years of age are rare. h will be of interest to the 
Btudent to note a number <>f oases that have oome under the 
observation <>t' the author. » 

Babies usually commence to Buck their fingers within ■ 
few hours after birth, In the majority of oases not later than 
the first week. The habit is therefore well fixed before 1 1 1 « - 
temporary teeth begin to erupt. This being t h«- case, the 
teeth and the alveolar process are naturally affected in their 
development ifthe pressure is continuous. The extent, shape 
and location of the irregularitj depends upon the hand 
employed and the position of the thumb and finger used. 
The right or left side are affected according to the hand used, 
though occasionally we find it in the median line. 




A- the child usually discontinues the habit before the 
time ^i the eruption of the permanent teeth, deformities pro- 
duced by thumb-sucking are usually confined to the tempor- 
ary BCt. 

Fiir. 232 shows the forward movement of the right central 
and lateral incisor. The model was taken from an impres 
sion of the teeth of a little girl two and a half year- (A' aire. 
While in the act ^\' sucking, the right arm re-ted upon the 
breast, and the ball of the thumb was directed against the 
palatine surface- of the incisors, which were carried forward. 
The child discontinued the habit at four. It will be observed 
that while the cutting-edges of the teeth have been slightly 
pressed forward, and a very slight impression ha- been made 
on the alveolar process, none was made on the roots of the 
teeth, and consequently no deformity exists where the germs 



478 ETIOLOGY OF OSSEOUS DEFORMITIES OF 

of the permanent teeth are located. After the child discon- 
tinued the habit, the teeth soon returned to their natural 
position, aided by the pressure from the lip. At this age the 
absorption and deposition of bone-cells is so active that very 
marked deformities are frequently corrected before the tem- 
porary teeth are lost, providing that the habit ceases in 
infancy. 

Fig. 233 shows quite a different deformity. Here we see 
the teeth fully developed, but a marked deformity existing 
at the median line. This case is that of a child six years of 
age. The thumb was held in the mouth so that the teeth 
came in contact with the thumb at right angles, preventing 
the development of the alveolar process. The teeth of the 




Fig. 233. 

inferior maxilla do not articulate properly with those of the 
superior, which is caused by the thumb having rotated upon 
the lower teeth after the upper had closed upon them. The 
hard palate was flat and normal, showing that the pressure 
was direct upon the teeth, and that the thumb did not come 
in contact with the tissues of the mouth. When the habit is 
continued during the development of the permanent set, the 
deformity is more marked, because there is more leverage, as 
is shown in Fig. 234. This is a case in which the palate is 
flat and normal, showing that the pressure was direct upon the 
teeth, and that the thumb did not come in contact with the 
tissues of the mouth. The superior jaw and teeth are brought 
forward by absorption and deposition of bone-cells, and the 
lower teeth and jaw are carried inward. 



I III HI M'. PACE, I \W S \M» I I I Ml 



179 



These cast's air >o unlike those of any other form oi irregu 
larity oi the permanent set thai it would seem imposeib • 
overlook the cause. The alveolar process and teeth assume 
the shape of the object or thing sucked. 

1 i 235 shows the front view of a case of thumb-sucking 
The teeth have developed t^eir norma] length; but arrest oi 





development of the superior alveolar process has taken 
place similar to Fig. 233. In Fig. 235 there has been quite a 
protrusion and forward movement of superior incisors and 
alveolar process, the teeth standing Can-shaped. The lower 
incisors are pressed inward and crowded together. The s] 
is greater on the right side than on the left, showing that the 
right hand was used. 



CHAPTER XXXVIII. 

CONCLUSIONS. 

The various influences which are brought to bear upon 
the present races of the earth which result in neuroses of 
degeneracy, in excessive and arrested development of the 
osseous system, have been discussed. Excessive and arrested 
development of the osseous system may be a direct inheri- 
tance. The children will possess structures similar to those 
of one or both parents, as when a child inherits an upper jaw 
from one parent and a lower jaw from the other, or inherits the 
jaws from one parent and the teeth from the other. Again, in 
a family of five children, four may inherit the jaws and teeth 
of the father, and the fifth the jaws and teeth of the mother. 
A neurotic brain may be transmitted which presides over the 
development of the osseous system, and thus occurs excessive 
or arrested development in the natural growth of the osseous 
system. It is a singular fact, there seems to be a tendency for 
neurotic individuals to seek each other's society. Hence the 
large number of literary societies which are being formed 
throughout the country, entertainments and social gatherings 
at which brilliant men and women are to be found. These 
individuals not only seek each other's society, but marriages 
are the rule among them. As a result children are born, 
who, if they live, in many cases become geniuses or possess 
unbounded egotism. They may become idiotic, deaf and 
dumb, blind, or late in life, insane, criminals or drunkards. 
Dr. Bannister,* after citing several instances in which the 
degenerate intermarried, expresses the opinion that such mar- 
riages constitute a potent factor in the perpetuation of neu- 
roses. Similar opinions are expressed by Dr. J. G. Kiernan f 
from observations of similar cases. He refers the degener- 
acy of genius to this factor. Genius attracts abnormal 
females as lighthouses do birds. Dr. Manning \ has found 

* American Lancet, Vol. VII. 

- 1 Neurological Review, Vol. I.; Alienist and Neurologist. Vol. XIII. 

X Australian Medical Gazette. 1885. 

480 



I II i HEAD, FACE, i \\\ - w i » i I i i ii I v I 

that the peculiar sympathy which Ihe neurotics have for each 
oihcr often results In marriage. The peculiarities of person* 
who visit their wives and husbands in insane hospitals are 
most remarkable, and it sometimes happens that the appar 
ently least insane membei of the family is under care, while 
tin- seemingly most pronounced lunatic is at large. Neabit, 
from his studies on genius, forms the conclusion that neuro 
paths seem to be drawn to each oihcr. The most remarkable 
illustration of this fondnessof neurotics for «:n li oilier is 
demonstrated in the Keeley hospital at Dwight, [llinois. 
Here are seen men o\' all professions, trades ami occupations, 
mingling together in the most social maimer. It will also 
account for the large number of " gold clubs " w hioh are being 
organized in different parts of the country. This sociability 

and affection are carried to the extent that, in most Cases, 

cards arc exchanged as tokens of remembrance and for the 
purpose of correspondence. 

Such marriages a- arc here mentioned are great factors in 
the production of a class of people whom we might expect to 
l>e not only deficient in mental stability, hut also in their 
osseous By 8 tern. Reasoning from this standpoint we would 
naturally expect to find an increase in abnormalities in older 

countries, where heredity i^ more concentrated. Thus, we 
would expect to find more deformities in people living in 
New England than in the Wot: a -till larger percentage in 
England and Europe than in New England. Extending our 
investigations >till further we would expect to find more neu- 
roses and degeneracy among the nobility of Europe than 
among the middle and lower classes. Mr. Cartwright n i 
nized the fact when he said that " Irregularity 18 common in 
most highly civilized communities, and especially so among 
the upper and middle classes." In accounting for the oon 
dition, he says that it is the result of high and selective 
breeding, and supports his position by illustration of the 
results of high breeding among animals. 

The comparison of uniting families, whether of nobility 



1 Infinity of 1 tenius, , 



4^'J ETIOLOGY OF OSSEOUS DEFORMITIES OF 

or otherwise, to the selective breeding of animals is not fully 
justified. In the one case, especially that of royal families, 
physical and mental conditions are rarely taken into consider- 
ation. The main point is the retention of position and rank 
socially and financially. The physical conditions are almost 
entirely ignored: the result is that neuroses and degeneracy 
have penetrated every household, stamping themselves not 
only upon the osseous, but all the different systems of the 
human bod}'. This, then, is selective breeding involving posi- 
tion and wealth. On the other hand, selective breeding of 
animals applies to their physical condition; ''low breeding " 
instead of u high breeding'' would be a preferable term. 

In families where neuroses and stigmata of degeneracy 
have been handed down for a number of generations, the 
deformities seem to be more markedly defined, and a large 
number result in one individual. This accounts for the larger 
number of criminals and paupers in Europe than in this coun- 
try, and the more marked deformities of the head, face, and 
jaws, as illustrated by Tarnowsky and Lombroso in their 
books, and in the magnificent exhibit of criminal anthropol- 
ogy by M. Bertillon at the World's Fair. When such cases 
are found they are usually of foreign birth. Deformities of 
the jaws seem to be more easily recognized than deformities 
of other bones, because the least deviation in the one or the 
other is observed, owing to their close proximity and the 
occlusion of the teeth. Deformities of the teeth are also very 
readily noticed. Adenoid growths, polypi, hypertrophy and 
atrophy of the bones and mucous membrane of the nose are 
more common among neurotics and degenerates, and the con- 
clusion must be that they are the result, first, of an unbal- 
anced nerve function, producing unstable blood-supply, and 
second, of an unbalanced bony framework. Tarnowsky and 
other scientists make quite a point of the atavistic characters 
of one or two teeth. We must not lose sight of the fact, how- 
ever, that many teeth deformities are due to local causes, 
and, therefore, are not stigmata of degeneracy. Elsewhere 
irregularities of the teeth have been classified into consti- 
tutional and local. There is quite a difference between the 



I III HIM'. 1 \< I . FAWfi \M» I I I I II 

two varieties. The constitutional variety always involves the 
jaw bone, develops with the osseous system, and are «tigniutfl 
ol degeneracy. The local irregularities (one, two or three 
teeth involved) are due to local causes, Bach as improper erup- 
tion, early or later extraction of the temporary teeth. They 
should not be considered in a diagnosis In connection with 
neuroses or degeneracy, lie author agre< \to with 

Dr. Alice Sollier, that "dental anomalies are verj common 
in degenerates," and would ge -till further and include 
neurotics. 

The loss ol the third molar and lateral incisor and 
deformities of the teeth are certainly Bigns of degeneracy, 
an.l an- always noticed in arrest of development of the bones 
of the face and jaws. Man\ cases occur in which degeneracy 
is stamped upon the face, while the teeth and alveolar pro 
arc normal. The troth of both jaws erupt and crowd their 
way into a normal position, thus showing that the jaws and 
teeth are regular, hut the depression from the ata of the nose 
upward is quite deformed. In the eruption of the teeth 
nature asserts her rights and comes to the re-cur. With all 
these condition- grouped under the two head- neuroses and 
degeneracy-— it is not strange that they should crop out in 
some form in nearly every family. Hence, inherited condi- 
tions will destroy many families in the fourth to the sixth 
generation. 

From the -tudy and comparison of the face, a- illustrated 
in the chapter on •• Deformities of the Face" (with the 
pictures and descriptions in chapter upon u Development of 
the Fa.*-"" . it is evident in every instance there is arrest of 
development at some period in the evolution to the sixth 
year. 

Fig. 54 shows arrest at the bridge of the nose, while 
all other hone- developed their normal -i/.c. This i- the 
earliest arrest that could take place Pig. 55 -how- arrest 
still later in life, and so on until we reach Fig. •'.". Arrest 
of the lower jaw may also take place ;,t any period in it> 
development. All these condition- not only -how arrest 
at some period in the early life of the child, hut also show 



484 ETIOLOGY OF OSSEOUS DEFORMITIES 

atavism, since these faces are found in many of the different 
races, such as the negro, Javanese, Bedouins, Esquimaux, 
and some tribes of Indians, as illustrated in Fig. 6. 

The fact has also been demonstrated that a person with a 
constitutional disease producing arrest of development of the 
jaws and facial bones may transmit them to his offspring, who 
inherit qualities which are acquired in the parent. 

Nothing has been said in regard to hereditary taint, such 
as disease, deformities, etc., becoming aborted in the offspring 
as a result of marriage. Such is frequently the case, but as 
this condition in no way enters into the subject under dis- 
cussion, it will be dismissed with this brief mention. 

Great stress has been laid upon the excessive development 
of the lower jaw by some physiognomists, in that it denotes 
strength and firmness of character, while my experience is 
that very little can be determined by it alone. Other signs 
must be taken into consideration before one can decide upon 
character by the size and shape of the lower jaw. The lower 
jaw is formed independent of the other bones of the head, and 
movable; it develops normally or is arrested. If excessively 
developed or arrested, it is just as liable to denote mental 
weakness as strength of character. This leads to the dis- 
cussion of the reason why criminals, prostitutes, drunkards, 
and in fact, all degenerates, possess stigmata. It should be 
remembered that degeneracy may lightly touch an organism 
or deeply affect it. The fact that stigmata of degeneracy in 
a light degree are often found among otherwise apparently 
normal persons, indicates that environment has much to do 
with the progress of development of degeneracy. Whether 
stigmata, as has been shown in children, are inherited or are 
the result of constitutional disease, they should equally receive 
constant attention of their parents, and should be sur- 
rounded with all the healthy comforts and influences of home 
life. Their associates should be carefully selected until they 
have attained maturity, or until their character is fixed. 
With this early careful attention from parents there would be 
fewer criminals, fewer drunkards, prostitutes and paupers in 
our charitable and correctional institutions. 



CHAPTER XXXIX. 

EXPLANATION OF PfcA l ES 

Plates I t<» 6 are lithographic illustrations of the upper 
jaw- of boys from an orphan asylum, ranging from rix to 
twelve years of age. They are drawn from casta <>t the mouths 
taken a- tin 1 , were sent into the office of the institution by 
the superintendent, regardless of condition, the only point 
taken into consideration being the age. The object of these 
illustrations is to show the progress oi the development of 
the second teeth, their relations to the temporary ones and 
also to the jaw. Notice the date, manner and formation of 
the normal V and saddle-shaped arches and their modifies 
dons. 

Plates 7 to 17 -how the shape of the teeth, alveolar pro 

re—, and vault at the median line of the above cases. 

Plate- 8 to I s show the shape of the teeth, alveolar pr<»- 
cess and vault at a line drawn laterally anterior to the first 
permanent molar of the above cases. 

Rates l'.' and 21 illustrate the shape of the teeth, alveolar 
process and vault at the median line, of twelve brachycephalic 
white adults. 'For measurements of these cases see pages 

344 to 347. 

Plate- 20 and 22 illustrate the shape ^i the teeth, alveolar 

process and vault at a line drawn laterally anterior to the 
first permanent molar, of twelve brachycephalic white adults. 

Plates 23 and 25 Show the shape of the teeth, alveolar pro 
cess and vault at the median line, of twelve mooeephalie white 
adults. 

Plates 24 and -J'', -how the shape ^i the teeth, alveolar pro 
less and vault at a line drawn laterally anterior to the first 
permanent molars of twelve mesocephalic white adults. 

Plate '11 -hows the -hape of the teeth, alveolar pn icess and 
vault at a median line of six dolichocephalic white adult-. 

186 



l s «'» ETIOLOGY OF OSSEOUS DEFORMITIES OF 

Plate 2s shows the shape of the teeth, alveolar process 
arid vault at a line drawn laterally anterior to the first per- 
manent molar of six dolichocephalic white adults. 

Plate 29 shows the shape of the teeth, alveolar process 
and the vault at the median line of six brachy cephalic colored 
adults. 

Plate 30 shows the shape of the teeth, alveolar process 
and vault at a line drawn laterally anterior to the first per- 
manent molar of six brachycephalic colored adults. 

Plate 31 shows the shape of the teeth, alveolar process 
and vault at the median line of six mesocephalic colored 
adults. 

Plate 32 shows the shape of the teeth, alveolar process and 
vault at a line drawn laterally anterior to the first permanent 
molar of six mesocephalic colored adults. 

Plate 33 shows the shape of the teeth, alveolar process 
and vault at the median line of six dolichocephalic colored 
adults. 

Plate 34 shows the shape of the teeth, alveolar process 
and vault at a line drawn laterally anterior to the first perma- 
nent molar of six dolichocephalic colored adults. 

Plate 35 illustrates the shape of the teeth, alveolar pro- 
cess and vault at the median line of six V-shaped vaults of 
white adults. 

Plate 36 illustrates the shape of the teeth, alveolar process 
and vault at a line drawn laterally anterior to the first perma- 
nent molars of six V-shaped vaults of white adults. 

Plate 37 illustrates the shape of the teeth, alveolar pro- 
cess and vault at the median line of six semi-V-shaped vaults 
of white adults. 

Plate 38 illustrates the shape of the teeth, alveolar pro- 
cess and vault at a line drawn laterally anterior to the first 
permanent molars of six semi-V-shaped vaults of white adults. 

Plate 39 illustrates the shape of the teeth, alveolar process 
and vault at the median line of six saddle-shaped vaults of 
white adults. 






I ill HEAD, i \< i | JAW8 \\ i» i i i i ii J -7 

Plate i" illustrates the shape oi the teeth, alveola] 

iH'ss mid \auli :u ;i I'm.- drawn laterally anterior t«» the first 
permanent molars <>t -i\ saddle Bhaped vaults <>t whiteadolts. 

Plate i i illustrates the shape <>t the teeth, alveolar pr 
and vault :ii the median line of -i\ semi saddle shaped vaults 

Oi White adults. 

Plate 12 illustrates the shape of the teeth, alveolar process 

and vault at a line drawn laterally anteriortothe first perma- 
nent molar of sis semi -ad. Mr vaults of white adult-. 



PLATE 1 

6 YEARS. 7 YEARS 









PLATE 2 

8 YEAR 









12 



PLATE 3 








13 



14 




15 






17 



18 



PLATE <% 

10 YEAR 





19 



•€*% 
* 





JK 



22 





^ 



24 



L.AT] 

II YEARS. 





25 



26 




! I 




27 



28 




29 




PL 

12 YEA. 





32 





34 




ANTEROPOSTERIOR AND LATERAL 



ILLUSTRATIONS OF THE VAULT 



PLATE 7 






Seven yctqrs orag<6. 





PLATE 8 



Six year.3 ofqge 






Seven yeqrsofqde 
4 






PLATE 9 






PLATE 10 
right years ofqgc. 






lo 





IZ 




PLATE 11 









PLATE 12 



l\lin« years of acu 
5 






16 




17 





PLATE 13 



Ten years of <jge 
I? 







PLATE li 



Ten veers of qgc 




21 




22 





24- 




PLATE 15 



Cfeyetf ytan ofcjde 








PLATE 16 



Ckven yeqn of age 



25 






z<t 





30 



PLATE 17 



Twelve yeorc of age 





PLATE 18 



Twelve yeqrs of ade 



31 




32 




35. 




54 




35 




36. 




PLATE 19 

Brqcbycefjhqlic. White 




PLATE 20 

Brcchycefihqlic White 






PLATE 21 

JBrqcfiyceJifiqlic. White 




PLATE 

BrqcfiycefrMic Whifc 



7 




8 





PLATE 23 

Mesoesrfihqlic. White. 




PLATE 2' 



Mesoccfihcilic. White 




PLATE 25 

Mesoccfrhqlic White 




PLATE 26 



Mesoccfihalic. Whife 






I! 



12 




PLATE 27 



DolidioceWialic. White 




PLATE 28 

Dolichocephalic. W/iife 





PLATE 29 



Brqchycefihqlic. Colored 




PLATE 30 

£>rqcfiycefifiqlic Colored 







6. 




PLATE 3d 



Mesocefihglic. Colored 




PLATE 32 

Mesoccfihalic. Colored. 

7 





12. 




PLATE 33 



Dolichocephalic. Colored. 




PLATE ;'i 



Dolichocephalic. Colored 








PLATE 35 
V 3h<jfie<3 Vqult. 




PLATE 36 

Vihqfied Vault 






PLATE 37 

5ew Vshqfiec/ Yqult. 




PLATE 38 

5<?rni Vshqfied Vault" 








PLATE 39 



3qcfc/le-5hqfiecf Vault". 




PLATE 40 



Saddle shajied Vciuif". 

T 




3 






6. 




PLATE 41 



Vmi-aa ddle Vqu lf. 






PLATE 42 
5cmi- sac/die Vautf 








INDEX 



I ■turn and Nutrition. . 162 

Acceleration end Retardation of 

I >. \ « It ■! um-iit 50 

Acquired Peculiarities, [nberitanoe 

of 18 

Adventitious Teeth 170 

African, Change of Shape of Bead 

in 

Alaska Indian-. Skulls of 268 

Alexander, H. < . B., <>n lust it 

of Children l-i 

On 1 Prostitution LBS 

Alveoli, Hypertrophy of.... L< - 
Alveolar Process, Development of '.•; 

Enlargement of 102 

Excessive size of in:, 

Inferior 

Strueture of 361 

Anoienl Etonians, Jaws of 67 

Andronico, on Prostitution L66 

Angles and Saxons in England .... 83 

Anglo-Sa\on>. laws of 6 

Animals, Changes in _1 

Antrum 

Description of _ M 

Diseases of 

Drainage of 

Neuroses of Development of . 28J 

Septa in 

Variations in 282 

Anterior Protrusion of Teeth. 166 

Arai>s. Varieties of 

Arch, Normal 102 

Contracted 

Saddle-shaped 419 

Semi-saddle Ill 

V-shaped l"l 

Semi -V-shaped 413 

Partial V- shaped 411 

Arrest of Development of Teeth.. .22* 
Arthur, on Dental Irregularities.. . 12 

Asymmetry of Maxilla 1 308 

Athenians. Jaws of 

Australians. -Taws of 



Ballard, '1 bos., on Thumb-em 

ing 
Bannister, M. M.. on Epileptic 

178 
< )n Intermarriage of i>. g 

crates 

Berth, Ruspini, <>n Bupernumen 

reetfa - 

Beannia and Bouchard, on Develop- 
ment of Pace 400 

Belgian < iauls in England ... 

Bell, Thos., on Dental irregulari- 
ties 7 

Bemis, S. M.. on [ntermarriage 212 
iikt. on Abnormality of struc- 
ture >i 

Berdmore, Thos., on Eletention of 
Teeth 1 

Bertillon. on Bodily Asymmt tr\ 

Bicuspid-. Deflection of H7 

Inferior. Irregularis.- of 

Malposition of 146 

Tartly Eruption of 147 

Black Race, Shape of Head in 

Blake, R., on Supernumerary Teeth 2 

Blind, the, Facial Deformities in. 298 

Blount. A. A., on Dental [rregulari- 

14 

Booth, Mrs. Ballington, on Prosti- 
tution I'd 

Bosworth, on Development of An- 
trum 

On Projection of Von • 

On Septum 

Brachycephalic Beads. 

Brachyoephalio Type i 

Brederman, W. K.. on Dental Di 

formities 12 

Britain, Races in 

Britons. Early. Size of -laws of 83 

Broca. Classification of Crania. . . .341 

On Typo of Head 

Brown. Dr 300 



11 



INDEX 



PAGE 

Buccinator Muscle, Action of 351 

Bushmen, Jaws of 55, 68 



Camper, on Facial Angle 231 

Canine Eminence 99 

Cantile, J., on City Life 221 

Canton, Alfr., on Dental Irregu- 
larities 12 

Carter, on Decay of Teeth 79 

Cartwright, S., on Close Breeding. 113 

On Deformities 481 

On Dental Irregularities 13 

Catlin, Geo., on Mouth-breathing. 10 

Celtic Language in Britain 33 

Cheek Bones 53 

Children, Degenerate. Rearing of. .484 

Chinese, Jaws of 67, 68 

Chinese and Japanese 27 

City Life, Causes of Danger in 222 

City versus Country Life 221 

Civilization and Dental Irregu- 
larity 9 

Clark, A. on Dental Irregularities . 11 
Clark. J. P., on Dental Irregulari- 
ties 9 

Classification of Dental Irregulari- 
ties 16 

Clay Shaw, on High Vault 328 

Cleft Palate, Acquired 397 

Classes of 397 

Congenital 397 

Embryology of 395 

Etiology of 395 

Frequency of 399 

In Animals 399 

Transmission of 398 

Clevenger, on High Cheek-bones... 53 

Climate. Changes of 18 

Close Breeding 113 

Clouston, on Deformity of Suture. 385 

On Neurotic Children 184 

On Vault 330 

Coleman and Cartwright, on Den- 
tal Irregularities 10 

Coles. Oakley, on Cleft Palate 396, 397 

Od Oral Deformities 204 

On Measurement of Skull .... 93 

On Dental Irregularities 9 

Cope. E. D.. on Physiognomy 47 

Combinations of V and Saddle- 
shaped Arches 426 



PAGE 

Comparative Degeneracy of For- 
eigners and Americans 250 

Compensatory Development 251 

Conclusions 480 

Consanguinity of Parents 209 

Constitutional Causes of Irregulari- 
ties 11 

Constitutional Lesions 227 

Contracted Arches 352 

Contracted Jaws 349 

Cravens, J. E., on First Permanent 

Molar 449 

Cretins, Jaws of 66 

Crime, in Animals 119 

In Plants 119 

Criminals. Deformities of Jaws in 159 

Left Handedness in 136 

Skulls of 137 

Crooke. Hilkiah, on Number of 

Teeth 1 

Cuspids, Importance of 441 

Inferior. Irregularities of 458 

Malposition of 441 

Cuylitz, on High Vault 328 



Dahl. Ludwig. on Idiocy in Nor- 
way 198.212 

Darwin, on Effects of Mental Con- 
centration 190 

On High Cheek-bones 53 

Davenport, on First Molar 453 

Deaf and Dumb. Deformities of 

Jaws in 301 

Deaf Mutism 300 

Deformities of Suture, 385 

Deformities of Vault 383. 393 

Deformities. Percentage of. in 

Different Countries 481 

Degeneracy. Doctrine of 115 

Of Foreigners and Americans 250 

Of Jaws and Teeth 56 

Table of 117 

Degenerates, Deformities of 115 

Immigrants in United States. 32 

Intermarriage of 480 

Delabarre, C. F.. on Dental De- 
formity 13 

De Lande, Chas.. on Dental Irregu- 
larity ' 8 

De Lessert. A. A., on Sucking 4 



INDKX 



III 



I >. Quatrefagee, i krlbutton 

ol 

- ' IB 
Diath- si> 

\ 287 

•,. r.t. .1. 1 1 

..portion between Jaws and 

.14 

Dolichocephalic Headi 

Dolichocephalic Tjrpe 

Down.. i. Langdon,onClef1 Palal 

On Developmental Defects... 9 

On Idiocy from [ntennar- 



On [dicta 

< to [ntem] le of 

idiocy -M 

On Palate in Idiocy 112 

On Vault in Idiots 

Domai 161 

Duval. J. I!., on Deformities. 19 



opment of Bone- 
Barly Brit. - I I 

• Lana 27 

i left Palate 

English, Deformities of 

Epilepsy, from Intemperance of 

Parents 

Epileptic Faeies 176 

Epilepties. Alveolar Hypertrophy 

in L06 

Misshapen Crania in 176 

Erupt is of 

Esquimaux, -laws of 

Ethiopians 

Etiology of Dental Irregularities L6 
Europeans, Changes of , in United 



Exercise. Development of Lower 

•Taw by 306 

Exophthalmus 

• f Vomer 



Face, Development of 

Farrar, on Women of Albania. 

Ferri. on ( riminal -Taws 1 J 1 

Finger-sucking 176 



Molar, irregularities fn 

of 

li.. on Maternal 
fmprc— loni 
Fitch, 8, 9 -li [rregnlarity of 

S 

I'Ut.h- r. M. H.. on DifM'RHO of 

antrum 
Flower, \\ . H.. < lasaincation «>f 

Heads ; 

On Typi of Bead I 

Forward Mown • • • I I ■ ■ • 
Fothergill, J. If., on Strum< 

Children 

Fox, Francis, <»n Thumb sucking , . 4 
Fox, Joseph, on Temporary Teeth, i 

Fuller. John, <<n Dental Irregu- 
larity 11 



Galton, Fr.. on Law- of Heredity, n 
( iarriot. -l . I:., on l teciduoufl Teeth 5 

< ienius 

Qhimes, s.„ <>n Underhung -law 
Goddard, Paul, on Dental Defor- 
mities II 

Graham, on 

• of Idiocy 

ser, on ' left Palate 

(iroham. on < riminals 

( irowth of Ma\ill;e 

(iunnell. on 1 'rotrusion of .law-. 13 



Habit, Effect of, on Offspring n 

Ham] 

Harbert, S , on Dental Irregulari- 

L2 

Harris, ' '. a., on Deformities 11 

Joseph, on Supernumerary 

Harrison Allen. <-' 

Vomer. ... 

On Septum 

Harting, < '.. on Increae 
Haskell, L P.,on Maxillary Defor- 
mities 310, 3H 

Haskell's Deformity 

Hawaiians. Skulls of 

Hawley. Dr 

Hebrews. Intermarriages Among.. 211 



IV 



INDEX 



PAGE 

Hepburn, on Irregularities of 

Teeth 10 

Heredity 38 

Modified by Climate and Soil. 39 

High Breeding 114 

Hippocrates, on Number of Teeth. 1 
Howe, S. G., on Causes of Idiocy 

198, 212 

Hottentots, Jaws of 55, 68 

Humphrey, G. M., on Growth of 

Jaw 6 

Hunt, Dr. Florence, on Jaws of 

Swedish Women 227 

Hunter, Natural History of Teeth. 5 

" Hutchinson's Teeth" 228 

Huth, on Intermarriage 209 

Huxley, on Genius 189 

Hypertrophy of Alveolae 393 



Idiocy 194 

Heredity in 198 

Idiots. Abnormally Shaped Heads 
in 202 

Brains of 199 

Deformities in 195, 197 

Imrie, J., on Thumb-sucking. . .2, 328 

Imperfect Occlusion 320 

Importance of Individual Teeth in 

Effecting Irregularities 431 

Incisors, Central, Importance of. .432 

Vicious Eruption of 436 

Lateral, Malposition of 437 

India, Races in 29 

Indo-European Race, Acceleration 

and Retardation in 50 

Inebriety 174 

Inferior Bicuspid 460 

Inferior Cuspid 458 

Inferior Maxilla, Asymmetry of 

Body of 316 

Inhalation and Exhalation, Gov- 
erning Development of Nasal 

Bones 264 

Insanity 114 

Intellectual Degeneracy 175 

Intemperance of Parents, as Cause 

of Idiocy 214 

Intermixture of Races 26 

Ireland, W. W., on Idiocy. . . .194. 198 
On Palate in Idiocy 112 



PAGE 

Irregularities of Teeth. Local 

Causes of 454 

Italians, Jaws of 67 

Ivy, R. S., on Vaults 334 



James, Ben j., on Retention of First 
Teeth 5 

Jaws, Abnormalties of from Race 
Mixture 81 

Correlation of with Extremi- 
ties 76 

Development of 55 

Growing Smaller 82 

Largest Normal 55 

Measurements of (tables }... 58-65 

Nutrition and Absorption of . .462 

Jaw, Lower, Angle of in Childhood 88 
Jews 27 

Hereditary Type of 40 

Jobson, D., on Dental Irregulari- 
ties ; 14 



Kansas, Climate of 23 

Keeley Institute, Neurotics in . . . .481 
Kiernan, J. G., on Intermarriage 
of Degenerates 480 

on Prostitutes 163 

Kingsley , Chas 231 

Kingsley, Dr., on Anterior Protru- 
sion 466 

— On Palate in Idiocy 112 

On Oral Deformities 10 

Knecht, on Cleft Palate in Crim- 
inals 399 

Koecker. L., on Temporary Teeth. 6 
Krafft-Ebing, on Moral Insanity. .172 



Lachrymal Duct. Stenosis of 298 

Langenbeck, on Exostoses of the 

Vomer 270 

On Cleft Palate 3% 

Lapps, Shape of Heads of 34 

Left-handedness in Criminals 136 

Le Foulon, J., on Thumb-sucking. 2 
Levison. J. L., on Contracted Jaw. !» 
Living Persons. Measurement of 

Jaws of 66 

Local Causes of Dental Irregulari- 
ties 431. 455 



IM'I \ 



•in » minimis 
( »n i nminal .law . 

On 1': L68 

- gn ..r i baraoto i . im 

Irregularitiea ol c 

. i'.. nn Orbital 1 1 
Lydston and Talbot, Studies ol 

Criminals l-'i 



McDonald, \. C, on Crania in 

Children 120 

McLean, EL, on Premature Kxt : 

tion of Firet T- eth. . 7 

Mackensie, <>n Exostoses ol Vomer.270 

( )n Septum -'l 

Magitot, on Decay of Teeth 7 ( .» 

llalar Bones, < toeification of 16 

liallan, John, on Dental Deformi- 

li 

Manning, Dr., on [ntermarriagi ol 

Neurotica i Mi 

On Pitcairn Uandera 209 

ManouTrier, on Criminal Jaw. l.i 
liarahpee Indian- 80, 31 

Martin. Hypolite, on Parental In- 

temperance aa ( ause of Epi* 

u l "» 

Maasachusette, Longevity in. . .226 

Registration ELeporte 226 

Mastication, I nsuse of 

Maternal Impressions l'In 

Mathews, W., on Month-breathing. 6 
Maury, F., on Prominence of Jaw. ll 
Maxilla, Inferior, Causes of asym- 
metry of ."'.li' 

Development of. by Exercu 

Protrusion of 

Superior, Development of. 16 

Protrusion of 

Maxillae, asymmetry of 306 

Maxillary Hones. Irregular Devel- 
opment of :m>i 

Maxillary Deformities, from V 

vous Disease .177 

In the Insane 178 

Maxillary Exercise. Arrest from 

Want of 77 

Merrick. Chaplain, on Prostitution. 162 

Mesocephalic Heads 

M' -oeephalic Type 'M 

Migration of Teeth 161 



Minnesota. < lunate ,,f 

Minting 1 1 eth, I 

Mixture of Rao - 

Causing abnormaltiea of 

-: 
Molar. i'ir-t . [mpoftaaoa i>f 

Irregularities from 

t ion of 
Molar, Third. A b s en ce of, in v 

roties 

Mongolians, Breadth of Skull In 77 

Mongolian EUOS, Aeeelerat ion ami 

Betardation in 

Moral Enaanit] 172 

Morel, on I tegenerac] l L6 

M« Tgagni, on Septum , 

Mortality in I 'dies 

Mortimer, on Dental [r r o g u laril 
Mosso. on Sexual < Mleiimr-. 
Mouth-breathing L7, 9 

In Idiocy, etc 108 

Mow, imen! of Teeth, Lenear. . 
Mulattoes, Peculiarities of.... 

Mummery. J. EL, OH S 'h. 7} 

On Width of arch 

Mummery and Nichols, on Teeth 

in Sa'. Igl - 10 

Murphy, Jos., on Retention of 

First Teeth 



Narrow .laws 

Nasal Bon< -. I tevelopmeni of 
Nasal t lartilagee, BSxc rel- 

opmelit of 

Nasal Cavity. Width of 

Nasmyth, on Structure of Teeth. 
Nationalities, Dnion of _ 

Neanderthal Type 76 

- in. m the United 
-l 

v gn • Eta leration and 

. iation in B0 

-is and Mental I ' » BSi B, 
Anomalies of -laws and Teeth 
in .177 

\. --. . I ompend, Zahnheilkuni 

Nettleship. on Kye Disease 597 

Neurotics. Definition of 11">. L81 

New England Famil • jesof 
Shape of Head in 36 



VI 



INDEX 



PAGE 

Nichols. J., on Dental Deformities. 7 

Nisbet, <5n Genius 191 

Normal Individuals. Deformities 

of Jaws in 302 

Normans and Danes 33 

North Germans. Shape of Head in 34 

Nose. Deflections of 274 

Nutrition and Absorption 462 



Occlusion. Perfect 461 

Ocular Affections from Deformed 

Orbits 296 

Open Mouth, Sleeping with 6 

Optic Neuritis 296 

Orang and Negro, Jaws of 19 

Orbit. Form of 149 

Orbital Deformity. Eye Disease 

from 297 

Orbits, Neuroses of Development 

of 293 

Variations of 293 

Originaere Verruecktheit 175 

Orthognathism 50 



Parmley, Lectures on Teeth 5 

Partial V-shaped Arch 357, 358 

Percy. Baron, on Maternal Impres- 
sions 219 

Perfect Occlusion 461 

Periods of Development 45 

Peruvian Skulls, Septum in.. 258, 263 

Plates, after page 487 

Polynesians, Jaws of 68 

Population, Concentration of 225 

Premature Extraction of Tempo- 
rary Teeth 6 

Prendergast. Patrick Eugene Jos.. 158 
Prognathism 50, 326 

In Negro 51 

Prostitutes. Anomalies in 169 

Ears of 164 

Skulls of 164* 167 

Stigmata in 1H2 

Prostitution and Degeneracy 161 

Protrusion (anterior) of Teeth. . . .465 

Puritans 55 

Putnam. Prof. J. W 30 

Pyncheon. Dr 360 



Quelmalz & Schultz, on Septum.. .254 



Races, Pure 27 

Intermixture of 26 

Rami, Asymmetry of 315 

Rearing of Degenerate Children. .484 
Recklingshausen, Von. on Crania. 1»;7 

"Red Bones" 31. 32 

Rengger, on Paraguay Indians. ... 7»J 

Retardation and Acceleration 50 

Retention of Temporary Teeth 4 

Reversion, Local 118 

Reversional Tendencies 207 

Rickey, on Dental Anomalies 473 

Rigg'sDisease 79 

Robertson, W.. on Dental Deform- 
ities 11 

Ross. H. D., on Correction of Teeth 4 

Rotation of Teeth 465 

Royal Families, Degeneracy in 482 

Royalty in England 42 

S 

Saddle-shaped Arch 15, 354, 419 

Description of 424 

Modification of 424 

Of Lower Jaw 430 

Salter, Thos.. on Thumb-sucking.. 4 

Samboes 29 

Savages. Acuteness of Senses in. . . 77 
Scandinavians. Decay of Teeth in. 22 
Schaus & Welcker. on Septum .... 255 
Scott, Jos., on Dental Irregulari- 
ties 7 

Semi-saddle Arch 357 

Semeleder. on Septum 251 

Semi- V-shaped Arch 357. 413 

Senses, Acuteness of in Savages. . . 77 
Septum, Deflection of by Air 265 

Deformities of 251 

Development of 258 

Deviation of Dependent on 

Development of Adjacent 

Bones 278 

Fracture of 256 

Molded by Aspiration 276 

Relation of to Turbinated 

Bones 261 

Sewell, H..on Dental Irregularity. 14 

Sexual Degeneracy 171 

Shirley, on Interbreeding in Deer. 211 
Shorthorn Cattle, Interbreeding in. 210 



I \ I . I \ 



VII 



PAS1 

Short-sight in Watchmakers, Sail- 

• ■■ 

Shuttleworth, on l tovelo] ml 

[dioti 

i )n Parental [ntemperanot 

■ t tanas ot" [dioo] .21 i. 816 

Sigmund, on [rregularitiei of 

U 

Skullfl of ' runinaU 187 

SiiIIut, Alice, on Dental anomali< 

South amerioane, Jawi «>f 

South Qermana, Shape of m. 

84 

Spac< i th MM 

Sphenoid, Development of 9 

Spooner, E., on Dental [rregulari- 

7 

Stenoaii of Lachrymal Duct. . 

Stigmata, Frequency of 248 

Stockton, Dental Intelligence 8 

Stockton-Hough, on Citj Life .--l 

Supernumerary Teeth l. 168 

Sutton, Miami, on Cleft Palate 396, 379 
Suture. Deformity of 

3, .laws of '17 



Talbot, on Dental Irregulari- 

15, 1»; 

Talbot and Lydston. Studies of 
Criminals 121 

Tarnowsky. on Atavistic Character 
of Teeth 482 

On cleft Palate in Prosti- 
tutes 399 

( )n Facial Anomalies 

On Prostitution 162 

Tartar on Teeth, from Want of 

Function 168 

Teeth, Atavistie < Iharactera of.. 182 
( Ihangee of 1 'osition of l(»7 

Direction of in Normal Vault. 393 

Forward Movement of l ,_ ' 

Insertion of LOT 

Irregularities of. Causing De- 
formed Vault 394 

Linear Movement of 463 

Local Causes of Irregularities 

of 431 

Migration of I'l 

Rotation of 

Size of 73 



l>> 
and -law 

of 

Temporary i ■ • th. Premsi 

traction ol 

R ete n tion of.... i 

Thrilr, on K\o-to», - ,,f \",, : 

On Septum 

Third MoIm 

Thompson, on Development of 
Pace l - 

Thornton, w . on Dental Irregu- 
larity 

Thumb-sucking 

as Cause of Sigh Vault.. 

Deform it its from 178 

Thumb and Finger Sucking 17«. 

Tiedemann, on cleft Palat 

Tomes, I . 8 . I tental 9 6 

On Decay of Teeth 78 

On Faulty Development of 

Alveoli 106 

( )n Size of Molars ....... 71 

Trendelenberg, on Septum 

Tschuvashes 29 

Tuberculosis, m Relation to Nasal 
Deformitiea 879 

Turbinated Bones, Arrest of Devel- 
opment of 

Excessive Development of 

268, 260, 268 

Tylor, on Intermarriage 210 

U 

Underhung -law 2 

Undeveloped Teal D 174 

V 
V-shaped Arch 16, 31 

Des cr iption <>f 

Formation <>f uv, 

Moditieations of U0 

Vancouver [aland Indians, skulls 

of -• 

Vault. Anatomy of M 

Antero-posterior Diameter of 69 

Date of Deformity of.... 

Development of 84,267,379 

Developmental N'eun - 

Grooves in 

High and Contracted, in 

Idiots 11- 

Height of 71. 90 



Vlll 



INDEX 



I' AGE 

Vault. Height of. in the Insane — 95 

Normal 92 

Normal Development of 86 

Ridges in 3*7 

Shape of Compared to that of 

Head 340 

Standard of Measurement of. 94 

Width of 51, 66, 96 

Vogt. on Diameter of Head 340 

Vomer, Deflection of by Air 265 

Ossification of 50 

Projections of 269 

Relations of, to Turbinated 

Bones 261 

Von Graefe, on Optic Neuritis 297 

W 

Waite, G., on Dental Irregularity.. 5 
Walther, on Cleft Palate 3% 



Weber, M. J., on Cleft Palate 396 

Weissmann. on Heredity 116 

West Indies, Habitability of.... 23, 24 
White. J. W., on Sucking Fingers. 4 

White Race, Shape of Head in 34 

White and Stellwagen. on Palate in 

Idiots 112 

Whitney. Dr. J. M 252 

Wilbur. C. T., on Intemperance as 

a Cause of Idiocy 214 

Wilmarth. A., on the Brains of 

Idiots 197 

Winck worth, on Supernumerary 

Teeth 2 

Wisdom-teeth. Size of 73 

z 
Ziem, on Development of Nasal 

Cavity • 275 

Zuckerkandl. on Septum 251 



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